What is the first-line treatment for chronic stable angina?

The first-line treatment for chronic stable angina is beta blockers. Beta blockers work by blocking the effects of adrenaline on the heart, which helps to decrease heart rate and myocardial oxygen demand. They also improve exercise tolerance and reduce the frequency of angina episodes, making them an effective choice for managing chronic stable angina.

In addition to their efficacy in lowering heart rate and blood pressure, beta blockers also have protective effects on the heart after a heart attack and can improve outcomes in patients with coronary artery disease. Because of these benefits, they are typically recommended as the initial therapy for patients experiencing chronic stable angina, particularly in those with a history of myocardial infarction or who have had ischemic events.

Other treatment options such as calcium channel blockers and long-acting nitrates can be useful, especially in patients who cannot tolerate beta blockers or have contraindications, but they are generally not considered first-line therapy. Ranexa (ranolazine) is often reserved for patients who have not responded adequately to first-line treatments, further indicating that beta blockers are prioritized in the management of chronic stable angina.