INIew Drugs Calcium antagonists , nitrates , and new antianginal drugs

Considerable progress in the medical as well as the surgical management of angina has been made in the past decade. An appreciation of the pharmacokinetics of the "oldest" antianginal drugs, the nitrates, has lead to the development of effective long acting preparations and novel techniques of administration. On the other hand, calcium antagonists represent a new approach to the treatment of angina as an alternative to the now well established beta-blockers, and the two are often complementary. We now have a greater understanding of how to reduce work done by the heart (hence oxygen consumption) and thus relieve angina. This may be achieved in various ways (fig 1) such as by reducing venous return (preload) with nitrates or by reducing heart rate (beta-blockers) or muscle contractility (beta-blockers, calcium antagonists) directly. The resistance against which the Calcium antagonists