Hoekenga D, Abrams J
Am J Med. 1984 Feb;76(2):309-14. doi: 10.1016/0002-9343(84)90791-5.
Important advances in understanding of the pathophysiology and medical treatment of angina pectoris have taken place in the past few years. Angina may occur from increased oxygen demands that cannot be met by a diseased coronary circulation and/or primary decrease in oxygen supply to the heart. Three major categories of pharmacologic agents are used in treating angina. Nitrates remain the first-line approach; they are inexpensive and available in many delivery forms. Beta blockers are also effective in the treatment of angina pectoris, and despite their side effects, are particularly useful in effort angina. The newest agents, the calcium channel blockers, are efficacious in all types of anginal syndromes. Each group of drugs acts differently on the various pathophysiologic mechanisms that contribute to the production of angina. This commentary critically reviews the major groups of anti-anginal drugs and places them in a clinical perspective. Guidelines for choosing an appropriate agent for the treatment of angina are proposed. Special situations, such as angina and hypertension, congestive heart failure, or post-myocardial infarction angina, are discussed with respect to selection of anti-anginal therapy. The proper utilization of nitrates, calcium channel blockers, and beta blockers, alone or in combination, provides a bright future for patients with ischemic heart disease.
在过去几年中，人们对心绞痛的病理生理学和医学治疗的理解取得了重要进展。心绞痛可能源于患病的冠状动脉循环无法满足增加的氧气需求和/或心脏的氧气供应原发性减少。治疗心绞痛使用三大类药物。硝酸盐仍然是一线治疗方法；它们价格低廉，有多种给药形式。β受体阻滞剂在治疗心绞痛方面也很有效，尽管有副作用，但在劳力性心绞痛中特别有用。最新的药物，即钙通道阻滞剂，对所有类型的心绞痛综合征都有效。每组药物对导致心绞痛产生的各种病理生理机制的作用不同。本评论批判性地回顾了主要的抗心绞痛药物组，并从临床角度对它们进行了阐述。提出了选择合适药物治疗心绞痛的指南。针对特殊情况，如心绞痛合并高血压、充血性心力衰竭或心肌梗死后心绞痛，讨论了抗心绞痛治疗的选择。单独或联合正确使用硝酸盐、钙通道阻滞剂和β受体阻滞剂，为缺血性心脏病患者带来了光明的前景。
