Freeman Spogli Institute for International Studies Program on Energy and Sustainable Development Stanford University


Evaluation of Beta-Blockers, Calcium Antagonists, Nitrates, and Alternative Therapies for Stable Angina

Evidence Report

Paul A. Heidenreich, Kathryn M. McDonald, Trevor J. Hastie, Bahaa Fadel, Vivian Hagan, Byron K. Lee, Mark A. Hlatky

Published by
UCSF-Stanford Evidence-Based Practice Center, Agency for Healthcare Research and Quality, November, 1999
Publication no. 00-E003, Evidence Report no. 10

Stable angina is a major health problem that affects over 7 million adult men and women in the United States, with an estimated 350,000 cases annually. Symptomatic therapy is targeted at either reducing oxygen demand by decreasing the work of the heart or increasing oxygen supply by dilating coronary arteries. Acute treatment of an angina episode consists of rest and often sublingual nitroglycerin. Chronic treatment to prevent symptoms has consisted of one or a combination of beta-blockers, calcium antagonists, and long-acting nitrates.

The choice of a first-line anti-anginal drug has been controversial because all three classes have been shown to be effective in relieving symptoms. There are few long-term trials comparing these drugs in controlled studies, and it is unclear whether any of the drug classes decrease mortality or myocardial infarction in patients with stable angina.

To address these important issues, the University of California, San Francisco-Stanford, Evidence-based Practice Center (EPC) conducted a thorough, systematic review and synthesis of the literature on treatment of stable angina and developed an evidence report on the topic. The topic was nominated by the American College of Cardiology, the American Heart Association, and the American College of Physicians. The EPC worked with the nominators' guideline committee to prioritize two topics for this project:

The relative efficacy and safety of beta-blockers, calcium antagonists, and long-acting nitrates in patients who have stable angina.

The efficacy of alternative therapies in patients who have stable angina.