Formation of antianginal pharmacotherapy in the historical aspect. From theoretical background to practical effect

Abstract

Angina pectoris is the most common form of chronic coronary insufficiency, treatment of which consists in reducing the number, duration and severity of anginal pains, as well as improving the prognosis: preventing the development of cardiovascular complications such as acute myocardial infarction, life-threatening rhythm disturbances and congestive heart failure. The treatment of coronary artery disease (CAD) has recently undergone significant changes. This is primarily due to the wide introduction into clinical practice of surgical and endovascular methods of myocardial blood flow restoration, which have moved the use of pharmacological of antianginal agents to the background. Despite this, the clinic continues to feel the need for drugs with anti-ischemic properties. This is due to the fact that there is a group of patients who, for various reasons, cannot undergo revascularization of the heart. This is due to the fact that there is a group of patients who, for various reasons, cannot undergo cardiac revascularization. These include individuals with morphological features of the coronary bed, technical obstacles to surgery, increasing number of cases of diabetic microangiopathy as a cause of myocardial ischemia, frequent recurrence of angina after coronary angioplasty. Finally, today we are not yet able to meet all the needs for myocardial revascularization. Thus, the clinical interest in antianginal therapy remains. The present review shows analysis of usage medications with various pharmacological properties in patients with angina in the historical aspect since the second half of the IX century, evolution of the researchers’ ideas about the mechanism of antianginal action, the amount of drugs used. A brief characteristic of modern antianginal drugs presented in the recommendations of the European Society of Cardiologists last revision (2019) is given.