In angina management, what is first-line therapy?

• A. Beta-blockers
• B. Nitrates
• C. Ranolazine
• D. Calcium channel blockers

Answer: (A)

Reducing myocardial oxygen demand is the main goal in stable angina, and beta-blockers achieve this best by slowing heart rate, reducing contractility, and lowering blood pressure. This combination decreases wall stress and oxygen consumption, which relieves angina symptoms and can improve exercise tolerance. They also carry a prognostic benefit in ischemic heart disease, making them the preferred starting antianginal therapy in most patients without contraindications. Nitrates are excellent for quick symptom relief but don’t prevent episodes or improve long-term prognosis. Calcium channel blockers are a good alternative or add-on if beta-blockers aren’t suitable, and ranolazine is typically reserved for refractory angina.