David Fitchett MD, FRCP(C), Cardiologist, St Michael’s Hospital, Associate Professor of Medicine, University of Toronto, ON.

Chronic stable angina is a common condition in older patients. Although lifestyle modifications such as weight loss, smoking cessation, and risk factor control remain fundamental components of the management strategy, pharmacological agents are necessary to prevent and control anginal symptoms. Sublingual nitroglycerin (either as tablets or a spray) is the most effective agent to terminate an episode of anginal pain. Anginal frequency and exercise tolerance are improved with beta-adrenergic blockers, calcium channel blockers, and long-acting nitrate preparations. A strategy for the optimal use of these agents both alone and in combination is discussed.

Key words: angina pectoris, nitrates, beta-blockers, calcium channel blockers.