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{{Chronic stable angina}}
{{Chronic stable angina}}


'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[John Fani Srour, M.D.]]; Jinhui Wu, M.D.
'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[John Fani Srour, M.D.]]; Jinhui Wu, M.D.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
 
==Overview==
In patient with stable angina, [[beta blockers]] are used as a first line of therapy for both '''symptomatic relief''' <ref name="pmid8044945">Pepine CJ, Cohn PF, Deedwania PC, Gibson RS, Handberg E, Hill JA et al. (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8044945 Effects of treatment on outcome in mildly symptomatic patients with ischemia during daily life. The Atenolol Silent Ischemia Study (ASIST)] ''Circulation'' 90 (2):762-8. PMID: [http://pubmed.gov/8044945 8044945]</ref><ref name="pmid9652879">Savonitto S, Ardissino D (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9652879 Selection of drug therapy in stable angina pectoris.] ''Cardiovasc Drugs Ther'' 12 (2):197-210. PMID: [http://pubmed.gov/9652879 9652879]</ref><ref name="pmid10448616">Thadani U (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10448616 Treatment of stable angina.] ''Curr Opin Cardiol'' 14 (4):349-58. PMID: [http://pubmed.gov/10448616 10448616]</ref> and for the '''prevention of ischemic events'''.<ref name="pmid7010157"> (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7010157 Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction.] ''N Engl J Med'' 304 (14):801-7. [http://dx.doi.org/10.1056/NEJM198104023041401 DOI:10.1056/NEJM198104023041401] PMID: [http://pubmed.gov/7010157 7010157]</ref> The mechanism of benefit include reduction in myocardial oxygen consumption by reducing the heart rate and myocardial contractility. Selective beta-1 blockers are preferred to non-selective beta-blockers due to fewer side effects associated with selective beta blocker.<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref> The most commonly used selective beta-1 blockers are [[metoprolol]], [[atenolol]], and [[bisoprolol]].


==Mechanisms of benefit==
==Mechanisms of benefit==
*Beta blocking drugs decrease [[heart rate]], [[blood pressure]], and contractility and, as a result, reduce myocardial oxygen consumption.
*Beta blockers decrease [[heart rate]], [[blood pressure]], and myocardial contractility and, as a result, '''reduce myocardial oxygen consumption'''.
*A slowing of heart rate is associated with an increased left ventricular perfusion time.
 
*Exercise induced increases in heart rate and blood pressure are also blunted. In patients with stable angina, beta adrenergic blocking agents increase exercise duration and the time to the onset of [[angina]] and of [[ST segment depression]], although the double product threshold (heart rate multiplied by blood pressure) at which [[ischemia]] occurs remains unchanged.
*A slowing of heart rate is associated with an increased left ventricular perfusion time. This '''prolonged diastole''' helps to improve perfusion to ischemic areas.
 
*Beta-blocker administration causes a '''reversal coronary steal phenomenon''' that results in shunting of blood from the non-ischemic to ischemic zone as a consequent of increased vascular resistance, thereby improving perfusion to ischemic areas.<ref name="pmid10860181">Kaufmann PA, Mandinov L, Seiler C, Hess OM (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10860181 Impact of exercise-induced coronary vasomotion on anti-ischemic therapy.] ''Coron Artery Dis'' 11 (4):363-9. PMID: [http://pubmed.gov/10860181 10860181]</ref>
 
*Beta-blockers blunt the effects of exercise such as increase in heart rate and blood pressure. In patients with stable angina, beta adrenergic blocking agents '''increase exercise tolerance''', reduce the time to the onset of [[angina]] and [[ST segment depression]] and also reduce [[Chronic stable angina nitrate therapy|short-acting nitrate]] consumption, although the double product threshold (heart rate multiplied by blood pressure) at which [[ischemia]] occurs remains unchanged. <ref name="pmid9652879">Savonitto S, Ardissino D (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9652879 Selection of drug therapy in stable angina pectoris.] ''Cardiovasc Drugs Ther'' 12 (2):197-210. PMID: [http://pubmed.gov/9652879 9652879]</ref><ref name="pmid10448616">Thadani U (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10448616 Treatment of stable angina.] ''Curr Opin Cardiol'' 14 (4):349-58. PMID: [http://pubmed.gov/10448616 10448616]</ref>


==Indications==
==Indications==
*It is beneficial to start and continue beta blocker drug therapy indefinitely in all patients who have had [[myocardial infarction]], [[acute coronary syndrome]] (ACS) or left ventricular dysfunction with or without [[heart failure]] symptoms, unless contraindicated.
*It is beneficial to start and continue beta blocker drug therapy indefinitely in all patients who have had [[MI|myocardial infarction]], [[acute coronary syndrome]] (ACS) or left ventricular dysfunction with or without [[heart failure]] symptoms, unless contraindicated.
*Beta blocking agents with beta selectivity (such as [[metoprolol]] and [[atenolol]]) are preferable in patients with mild [[asthma]], [[chronic obstructive pulmonary disease]] (COPD), [[insulin dependent diabetes mellitus]] (IDDM) or intermittent [[claudication]]. However, with increased doses of beta blockers, selectivity is lost and both types of beta receptors are blocked.
 
*Beta blocking agents with beta selectivity (such as [[metoprolol]] and [[atenolol]]) are preferable in patients with mild [[asthma]], [[chronic obstructive pulmonary disease]] (COPD), [[insulin dependent diabetes mellitus]] (IDDM) or intermittent [[claudication]]. However, with increased doses of beta blockers, selectivity is lost and both types of beta receptors are blocked.  
 
*In patients with [[heart failure]], selective beta-1 blockers such as [[metoprolol]] or [[bisoprolol]] have been shown to effectively reduce cardiac events and prolong survival.<ref name="pmid10376614"> (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10376614 Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF)] ''Lancet'' 353 (9169):2001-7. PMID: [http://pubmed.gov/10376614 10376614]</ref><ref name="pmid10023943"> (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10023943 The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial.] ''Lancet'' 353 (9146):9-13. PMID: [http://pubmed.gov/10023943 10023943]</ref> Non selective beta blockers such as [[carvedilol]] has also shown to reduce mortality in patients with heart failure.<ref name="pmid8614419">Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM et al. (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8614419 The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group.] ''N Engl J Med'' 334 (21):1349-55. [http://dx.doi.org/10.1056/NEJM199605233342101 DOI:10.1056/NEJM199605233342101] PMID: [http://pubmed.gov/8614419 8614419]</ref>


==Contra-indications==
==Contra-indications==
*Beta-blockers with '''intrinsic sympathomimetic activity''' have shown to provide less benefit in the reduction of mortality [[MI|post-MI]], hence are avoided.<ref name="pmid12007080">Freemantle N, Urdahl H, Eastaugh J, Hobbs FD (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12007080 What is the place of beta-blockade in patients who have experienced a myocardial infarction with preserved left ventricular function? Evidence and (mis)interpretation.] ''Prog Cardiovasc Dis'' 44 (4):243-50. PMID: [http://pubmed.gov/12007080 12007080]</ref>
*If administration of beta blockers induces symptomatic [[heart failure]], they should be discontinued or the dose reduced.
*If administration of beta blockers induces symptomatic [[heart failure]], they should be discontinued or the dose reduced.
*The sudden withdrawal of beta blocker therapy may result in worsening of angina (rebound effect) and precipitation of acute ischemic episodes; it is preferable to taper these medications gradually over 2 to 3 weeks.
 
*Severe [[bradycardia]],
*Severe [[bradycardia]]
*Episodes of second or third degree atrioventricular (AV) blocks,
*Episodes of second or third degree [[atrioventricular block|AV blocks]].
 
*Severe [[peripheral vascular disease]]
*Severe [[peripheral vascular disease]]


==Dosage==
==Dosage==
*The effective dose of any beta blocker drug varies considerably from patient to patient.
*The effective dose of any beta blocker drug varies considerably from patient to patient.
*For an effective treatment, resting heart rate should be reduced to between 45 and 60 bpm (beats per minute) and heart rate should be below 90 beats per minute during moderate exercise, such as climbing two stairs at a normal pace.  
*For an effective treatment, resting heart rate should be reduced to between 45 and 60 bpm (beats per minute) and heart rate should be below 90 beats per minute during moderate exercise, such as climbing two stairs at a normal pace.  
*For maintenance therapy of stable angina, beta blocking drugs with a relatively long half-life are preferable.  
*For maintenance therapy of stable angina, beta blocking drugs with a relatively long half-life are preferable.  
==Drug interaction==
*Beta blockers when used concomitantly with [[diuretics]], may increase the blood sugar level and '''reduce insulin sensitivity'''.
*In patients with [[insulin dependent diabetes mellitus]] (IDDM), beta-blockers may '''mask [[hypoglycemic]] symptoms'''.


==Adverse effects==
==Adverse effects==
*Major side effects of beta blocker therapy include fatigue, impaired exercise tolerance, [[depression]], [[insomnia]], nightmares, and worsening [[claudication]] and [[bronchospasm]].
*In patients with [[Coronary Vasospasm|vasospastic angina]], beta-blocker therapy may precipitate symptoms.
*Beta blockers may increase the blood sugar level and impair insulin sensitivity, particularly when used concurrently with [[diuretics]]. They may decrease the reaction to hypoglycemia in patients with [[insulin dependent diabetes mellitus]] (IDDM).
 
*Beta blockers also may exert unfavorable effects on the blood lipid profile with an increase in [[triglycerides]] and reduction in high density lipoprotein ([[HDL]]-C). However, the clinical significance of these adverse changes in the lipid profile with beta blockers has not yet been defined.
*The sudden withdrawal of beta blocker therapy may result in worsening of angina ('''rebound effect''') and precipitation of acute ischemic episodes. Hence it is preferable to taper these medications gradually over 2 to 3 weeks.
 
*Major side effects of beta blocker therapy include:
:*Symptomatic [[bradycardia]]  
:*[[Bronchospasm]]  
:*Worsening [[claudication]]  
:*Impaired exercise capacity <ref name="pmid9652879">Savonitto S, Ardissino D (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9652879 Selection of drug therapy in stable angina pectoris.] ''Cardiovasc Drugs Ther'' 12 (2):197-210. PMID: [http://pubmed.gov/9652879 9652879]</ref><ref name="pmid10448616">Thadani U (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10448616 Treatment of stable angina.] ''Curr Opin Cardiol'' 14 (4):349-58. PMID: [http://pubmed.gov/10448616 10448616]</ref>
:*[[Insomnia]], [[nightmares]]
:*[[Fatigue]] and sexual dysfunction <ref name="pmid12117400">Ko DT, Hebert PR, Coffey CS, Sedrakyan A, Curtis JP, Krumholz HM (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12117400 Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction.] ''JAMA'' 288 (3):351-7. PMID: [http://pubmed.gov/12117400 12117400]</ref>
 
*Beta blocker induced changes in lipid profile such as an increase in [[triglycerides]] and reduction in high density lipoprotein ([[HDL|HDL-C]]) have not yet been defined.


==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT) <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref><ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>==
==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT) <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref><ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>==
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Revision as of 15:40, 22 August 2011

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [5]; John Fani Srour, M.D.; Jinhui Wu, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

In patient with stable angina, beta blockers are used as a first line of therapy for both symptomatic relief [1][2][3] and for the prevention of ischemic events.[4] The mechanism of benefit include reduction in myocardial oxygen consumption by reducing the heart rate and myocardial contractility. Selective beta-1 blockers are preferred to non-selective beta-blockers due to fewer side effects associated with selective beta blocker.[5] The most commonly used selective beta-1 blockers are metoprolol, atenolol, and bisoprolol.

Mechanisms of benefit

  • Beta blockers decrease heart rate, blood pressure, and myocardial contractility and, as a result, reduce myocardial oxygen consumption.
  • A slowing of heart rate is associated with an increased left ventricular perfusion time. This prolonged diastole helps to improve perfusion to ischemic areas.
  • Beta-blocker administration causes a reversal coronary steal phenomenon that results in shunting of blood from the non-ischemic to ischemic zone as a consequent of increased vascular resistance, thereby improving perfusion to ischemic areas.[6]
  • Beta-blockers blunt the effects of exercise such as increase in heart rate and blood pressure. In patients with stable angina, beta adrenergic blocking agents increase exercise tolerance, reduce the time to the onset of angina and ST segment depression and also reduce short-acting nitrate consumption, although the double product threshold (heart rate multiplied by blood pressure) at which ischemia occurs remains unchanged. [2][3]

Indications

  • In patients with heart failure, selective beta-1 blockers such as metoprolol or bisoprolol have been shown to effectively reduce cardiac events and prolong survival.[7][8] Non selective beta blockers such as carvedilol has also shown to reduce mortality in patients with heart failure.[9]

Contra-indications

  • Beta-blockers with intrinsic sympathomimetic activity have shown to provide less benefit in the reduction of mortality post-MI, hence are avoided.[10]
  • If administration of beta blockers induces symptomatic heart failure, they should be discontinued or the dose reduced.

Dosage

  • The effective dose of any beta blocker drug varies considerably from patient to patient.
  • For an effective treatment, resting heart rate should be reduced to between 45 and 60 bpm (beats per minute) and heart rate should be below 90 beats per minute during moderate exercise, such as climbing two stairs at a normal pace.
  • For maintenance therapy of stable angina, beta blocking drugs with a relatively long half-life are preferable.

Drug interaction

  • Beta blockers when used concomitantly with diuretics, may increase the blood sugar level and reduce insulin sensitivity.

Adverse effects

  • The sudden withdrawal of beta blocker therapy may result in worsening of angina (rebound effect) and precipitation of acute ischemic episodes. Hence it is preferable to taper these medications gradually over 2 to 3 weeks.
  • Major side effects of beta blocker therapy include:
  • Beta blocker induced changes in lipid profile such as an increase in triglycerides and reduction in high density lipoprotein (HDL-C) have not yet been defined.

ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT) [5][12][13]

“

Class I

1. It is beneficial to start and continue beta-blocker therapy indefinitely in all patients who have had MI, acute coronary syndrome, or left ventricular dysfunction with or without heart failure symptoms, unless contraindicated. (Level of Evidence: A)

2. Beta-blockers as initial therapy in the absence of contraindications in patients without prior MI. (Level of Evidence: B)

”

ESC Guidelines- Pharmacological therapy to improve symptoms and/or reduce ischaemia in patients with stable angina (DO NOT EDIT) [14]

“

Class I

1. Test the effects of a beta-1 blocker, and titrate to full dose; consider the need for 24 h protection against ischemia. (Level of Evidence: A)

2. In case of beta-blocker intolerance or poor efficacy attempt monotherapy with a CCB (Level of evidence: A), long-acting nitrate (Level of evidence: C), or nicorandil. (Level of evidence: C)

3. If the effects of beta-blocker monotherapy are insufficient, add a dihydropyridine CCB. (Level of evidence: B)

Class IIa

1. In case of beta-blocker intolerance try sinus node inhibitor. (Level of evidence: B)

2. If CCB monotherapy or combination therapy (CCB with beta-blocker) is unsuccessful, substitute the CCB with a long-acting nitrate or nicorandil. Be careful to avoid nitrate tolerance. (Level of evidence: C)

”

ESC Guidelines- Pharmacological therapy to improve prognosis in patients with stable angina (DO NOT EDIT) [14]

“

Class I

1. Oral beta-blocker therapy in patients post-MI or with heart failure. (Level of Evidence: A)

”

Vote on and Suggest Revisions to the Current Guidelines

Sources

  • The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [5]
  • TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [12]
  • Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [14]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [13]

References

  1. ↑ Pepine CJ, Cohn PF, Deedwania PC, Gibson RS, Handberg E, Hill JA et al. (1994) Effects of treatment on outcome in mildly symptomatic patients with ischemia during daily life. The Atenolol Silent Ischemia Study (ASIST) Circulation 90 (2):762-8. PMID: 8044945
  2. ↑ 2.0 2.1 2.2 Savonitto S, Ardissino D (1998) Selection of drug therapy in stable angina pectoris. Cardiovasc Drugs Ther 12 (2):197-210. PMID: 9652879
  3. ↑ 3.0 3.1 3.2 Thadani U (1999) Treatment of stable angina. Curr Opin Cardiol 14 (4):349-58. PMID: 10448616
  4. ↑ (1981) Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 304 (14):801-7. DOI:10.1056/NEJM198104023041401 PMID: 7010157
  5. ↑ 5.0 5.1 5.2 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [1] PMID: 10351980
  6. ↑ Kaufmann PA, Mandinov L, Seiler C, Hess OM (2000) Impact of exercise-induced coronary vasomotion on anti-ischemic therapy. Coron Artery Dis 11 (4):363-9. PMID: 10860181
  7. ↑ (1999) Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) Lancet 353 (9169):2001-7. PMID: 10376614
  8. ↑ (1999) The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 353 (9146):9-13. PMID: 10023943
  9. ↑ Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM et al. (1996) The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med 334 (21):1349-55. DOI:10.1056/NEJM199605233342101 PMID: 8614419
  10. ↑ Freemantle N, Urdahl H, Eastaugh J, Hobbs FD (2002) What is the place of beta-blockade in patients who have experienced a myocardial infarction with preserved left ventricular function? Evidence and (mis)interpretation. Prog Cardiovasc Dis 44 (4):243-50. PMID: 12007080
  11. ↑ Ko DT, Hebert PR, Coffey CS, Sedrakyan A, Curtis JP, Krumholz HM (2002) Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA 288 (3):351-7. PMID: 12117400
  12. ↑ 12.0 12.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[2] PMID: 12515758
  13. ↑ 13.0 13.1 Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[3] PMID: 17998462
  14. ↑ 14.0 14.1 14.2 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.


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