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European Heart Journal 1997 18(Supplement B):27-34; doi:10.1093/eurheartj/18.suppl_B.27
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

Pharmacological treatment of ischaemic heart disease

Monotherapy vs combination therapy

P. F. Cohn

Department of Medicine, Division of Cardiology, State University of New York Health Sciences Center Stony Brook, New York, U.S.A.

Correspondence: Dr Peter F. Cohn, Cardiology Division, Health Sciences Center (T-l7-020), Stony Brook, New York 11794-8171, U.S.A.

Non-invasive treatment continues to be the mainstay of anti-ischaemic therapy. The imbalance between myocardial oxygen supply and demand provides the basis for myocardial ischaemia, which may present as symptomatic, asymptomatic or, in most cases, a mixture of the two. Both symptomatic and silent ischaemia are major prognostic indicators in patients with coronary artery disease and treatment should therefore be directed towards both the amelioration of symptoms and the resolution of the signs of ischaemia. Anti-ischaemic therapy may decrease oxygen demand, increase myocardial oxygen supply, or both. Interventional therapies, such as percutaneous transluminal coronary angioplasty and bypass grafting, improve supply but do not alter demand. Drug therapy is associated with a variety of effects upon both supply and demand, depending upon the agent used. Nitrates alter both myocardial oxygen supply and demand, while β-blockers decrease myocardial oxygen demand. Calcium channel blockers reduce afterload and myocardial contractility and, thus, lower oxygen demand, while the coronary artery relaxation that occurs in response to their use acts to increase supply. The use of combination therapy, is considered by many to be the most rational approach to the treatment of myocardial ischaemia, in that it allows maximal reduction in demand and increase in supply.

Key Words: Ischaemic heart disease • β-blockers • calcium channel blockers • nitrates • combination therapy


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