Clinical Evaluation of Beta-Blockers in Various Forms of Angina Pectoris
Beta-receptor blockers have been used in ischemic heart disease, especially in angina pectoris, since the late 1960s. Their evaluation has considered clinical findings, including symptoms, ischemic endpoints (such as myocardial infarction), and the need for revascularization, as well as investigative measures, such as signs of ischemia at exercise testing and during long-term ECG recording. It has been clearly shown that beta-blockers have beneficial effects on anginal symptoms and the signs of myocardial ischemia. However, whether there really is a primary preventive effect in patients with stable angina (as has been shown for post-MI patients) has not been studied. This chapter discusses the various mechanisms behind the beneficial effects of betablockers that may also influence prognosis, as well as some methodological problems related to clinical trials with beta-blockers.
KeywordsAngina Pectoris Unstable Angina Stable Angina Myocardial Oxygen Consumption Angina PECTORIS
Unable to display preview. Download preview PDF.
- 2.Downey HF, Bashour FA, Mandel T, Kechejian SJ, Underwood RH. Effects of isoproterenol on collateral blood flow in ischemic myocardium. Annual Meeting of the Midwest Section of the American Federation for Clinical Research, 1973.Google Scholar
- 3.Fox K, Jonathan A, Selwin A. Combined high dosage administration of nifedipine and propranolol in patients with angina pectoris. Clin Sci 1980;58:11–12.Google Scholar
- 6.Hjemdal P, Linde B. Adrenergic control of blood flow and lipolysis in human adipose tissue. In: H Refsum, OD Mjoes, eds. Alpha-Adrenoceptor Blockers in Cardiovascular Disease. Churchill Livingstone 1985:151–164.Google Scholar
- 7.Clausen T. Adrenergic control of Na+-K+ home-ostasis. Acta Med Scand 1983,(Suppl 672):111–115.Google Scholar
- 8.Kerry R, Scrutton MC. Platelet adrenoceptors. In: GL Longenecker, ed. The Platelet: Physiology and Pharmacology. Academic Press, 1985:113–157.Google Scholar
- 9.Winter K. The effect of betablockade on platelet function and fibrinolytic activity. J Cardiovasc Pharmacol 1987;10(Suppl 2):94–98.Google Scholar
- 13.ISIS I. Randomised trial of intravenous atenolol among 16,027 cases of suspected myocardial infarction. Lancet 1986;2:57–66.Google Scholar
- 20.Ardissino D, Savonitto S, Egstrup K, et al. Selection of medical treatment for stable angina pectoris. Result of the International Multicenter AnGina Exercise Study (IMAGE), in press.Google Scholar
- 29.Lundin P, Eriksson SV, Erhardt L, Strandberg LE, Rehnqvist N. Continuous vector cardiography in patients with chest pain suggestive of acute ischemic heart disease. Cardiology, in press.Google Scholar