COMBINATION MEDICAL THERAPY IN THE TREATMENT OF ANGINA-PECTORIS

An aggressive medical approach is required for certain patients with severe angina pectoris when the coronary anatomy is not suitable for surgical revascularization or angioplasty or when the surgical risk is prohibitive. Combination medical therapy is effective in many patients, reducing the frequency of angina pectoris and nitroglycerin consumption while improving exercise-related parameters. Calcium-channel antagonists, beta-blockers, long-acting nitrates, sublingual nitroglycerin, and aspirin are available for use. Various combinations of antianginal medications can be successfully used, provided that the clinician is knowledgeable about the pharmacology of each individual medication, possible drug interactions, and all important medical problems affecting the patient. Usually, even complex antianginal regimens are tolerated reasonably well if medications are added in sequence and titration is gradual.