Comparative effects of calcium entry-blocking drugs, beta-blocking drugs, and their combination in patients with chronic stable angina.

For monotherapy, beta-blockers and calcium-entry blockers are effective and safe antianginal medications. For prophylaxis of myocardial ischemia, a different mechanism of action for each class of drugs is reflected by the different heart rate and rate-pressure product during exercise. In patients who continue to have anginal symptoms despite adequate beta-blockade, further alleviation of symptoms together with an increase in exercise tolerance may be observed with the addition of a calcium-entry blocker. Of note is the individual patient response to the various calcium-entry blockers when combined with propranolol. Although of theoretic concern with combination therapy, no deleterious effect on left ventricular function or increased adverse clinical effects were noted in our studies. Combination therapy with beta-blockers and calcium-entry blockers is well tolerated, effective, and safe both over the short and long term in patients with exertional angina.