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Author: Admin | 2025-04-28
Whereas beta blockers are initial therapy for long-term relief. A CCB or long-acting nitrate should be added if beta blockers do not control symptoms. CCBs can be used as first-line therapy in patients who cannot tolerate or who have a contraindication to beta blockers. Ranolazine (Ranexa) can be added to beta-blocker or CCB therapy if monotherapy is ineffective or not tolerated1,2 (Table 21,2,26–36 and Figure 21,2,26–36,58–62). Algorithm for management of stable coronary artery disease.Information from references 1, 2, 26 through 36, and 58 through 62."> BETA BLOCKERS Beta blockers improve survival and reduce MI recurrence in patients with a recent MI and in those with abnormal left ventricular function. In these patients, beta-blocker therapy is recommended for up to three years.1,2,27,28 However, beta blockers are not associated with reduced rates of cardiovascular events in patients without MI, and may increase the risk of stroke.27 Beta blockers are effective antianginals and are recommended as initial therapy in patients with stable CAD if they can be tolerated.1,2 Agents that are cardioselective for blocking β1 receptors (i.e., metoprolol, atenolol, bisoprolol) are preferred to minimize the risk of adverse effects. Metoprolol succinate (Toprol XL) or carvedilol (Coreg) should be used in patients who have heart failure with reduced ejection fraction. CALCIUM CHANNEL BLOCKERS Dihydropyridine CCBs (e.g., amlodipine [Norvasc], nifedipine) and nondihydropyridine CCBs (e.g., verapamil, diltiazem) are effective antianginal agents. However, short-acting CCBs may cause reflex tachycardia, potentially exacerbating ischemia and increasing the risk of harm, and are not recommended.29–32 Long-acting formulations such as amlodipine or extended-release nifedipine should be used instead. A meta-analysis of 100 RCTs found that unlike beta blockers, long-acting CCBs have no effect on all-cause or cardiovascular mortality, but reduce episodes of angina pectoris by 18%.33 CCBs should not be used in patients with abnormal left ventricular function because of lack
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