Pharmacological approaches to the symptomatic treatment of chronic stable angina: a historical perspective and future directions.

Current pharmacological treatment for the symptoms of chronic angina consists of nitrates, beta-blockers and calcium antagonists, which were introduced for use in 1867 (England), 1973 (United States) and 1982 (United States), respectively. There has not been a new class of drugs approved for symptomatic relief of chronic angina in the past 22 years. In the present review, the author discusses several new pharmacological approaches currently being tested, each with potentially different mechanisms of action. The proposed mechanisms of action of some of the new experimental drug classes that have proven antianginal and/or anti-ischemic properties may evolve or even change as newer science that more clearly elucidates how specific drugs work becomes available. Indeed, the mechanism whereby nitroglycerin exerts its action took 130 years to fully understand. The experimental drugs discussed in the present review are currently not approved for use in North America.