By James M. Rippe

As you can see in the following list, some of the medications prescribed to manage blood pressure and cholesterol are also used in treating angina. There are also additional important medications prescribed for the symptoms of angina. The following list highlights the roles of these common medications:

  • Nitrates: Nitrates, particularly nitroglycerin, are valuable mainstays for treatment of angina. They relieve pressure on the heart and may also increase blood flow to the heart by causing the coronary arteries to dilate. Nitroglycerin often relieves discomfort quickly.

    Nitroglycerin/nitrates may come in the form of tablets or sprays that you put under the tongue, a pill that you take by mouth, a cream that you apply to your skin, or a patch that you wear on your skin. Some people may experience headache as a side effect.

  • Beta blockers: These medications, another mainstay of treatment, decrease how hard the heart must work by lowering blood pressure and decreasing heart rate. (For more on how beta blockers work, refer to the earlier section “Lowering high blood pressure.”)

  • Calcium channel blockers (also called calcium antagonists): This class of medicines blocks calcium flow into the muscle cells of arteries and enables arteries to dilate. They typically are less effective than nitrates and beta blockers in angina treatment; however, calcium antagonists may be used in conjunction with them. Calcium antagonists are particularly useful when any significant degree of spasm of the coronary arteries is present.

  • ACE inhibitors: These drugs also help to relax or widen the blood vessels. They appear to be particularly helpful to people who have microvascular disease (narrowings of the small arteries of the heart, not the large arteries) or diabetes.

  • Ranolazine: This relatively new anti-ischemic medication is used to help relax coronary blood vessels. Unlike some other drugs, however, it does not affect heart rate or blood pressure. It is usually prescribed with other drugs such as nitroglycerin or beta blockers.

  • Aspirin: That’s right, good old aspirin. Many people know that aspirin can relieve minor pain or fever, but they don’t know that aspirin is important in treating angina because it helps prevent platelets from sticking to the walls of blood vessels and thereby contributing to any blood clot that may narrow or block off a coronary artery. Aspirin needs to be part of therapy for individuals with known or suspected CHD who haven’t experienced any problems with bleeding.

    Research and experience show that using enteric, or coated, aspirin, which dissolves in the intestine, often helps lessen potential stomach irritation in some individuals who are sensitive to aspirin.

  • Anticoagulants and antiplatelet drugs: The purpose of these drugs is to prevent clots on plaques from forming and prevent platelets from sticking together and contributing to clots. The goal is to prevent a heart attack.

    Some of these drugs may be used with aspirin to manage stable angina; others may be administered in the hospital to help in the acute setting of unstable angina. These drugs are also used to prevent strokes in people with an irregular heart rhythm, known as atrial fibrillation.