Drug treatment of stable XXXX in the elderly: defining the place of @entity460 channel antagonists.

@entity1 @entity296 @entity712 @entity583 @entity101 @entity1855 @entity5749 @entity3988 @entity951 @entity460 @entity594 @entity453
@entity5749 ( @entity5749 ) resulting from @entity453 ( @entity453 ) is common in elderly @entity1 , and significantly reduces their quality of life. Myocardial revascularisation procedures in this age group entail significant risks, largely related to comorbidities rather than advanced age itself. Coronary artery anatomy is more likely to be technically unsuitable for revascularisation and angina more resistant to drug treatment. Therefore, elderly @entity1 often take combinations of antianginal drugs. @entity460 channel antagonists (CCAs) are effective antianginal drugs first introduced for clinical use in the late 1970's. They reduce @entity296 by both causing vasodilatation of coronary resistance vessels and reducing cardiac workload (negative inotropic effect). However, adverse effects related to abrupt arterial vasodilatation limited the tolerability of these short acting 'first generation' drugs ( @entity594 , @entity1855 and @entity3988 ). Furthermore, short acting @entity594 may occasionally increase both the frequency of @entity951 and mortality in @entity1 with @entity453 . Since then, long acting formulations of first generation agents and new chemical entities (second and third generation drugs) have been developed. These are well tolerated and effective at attenuating both @entity296 and the frequency and severity of @entity951 in most @entity1 with stable @entity453 . Current guidelines on the drug treatment of @entity5749 propose that beta-adrenoceptor antagonists (beta-blockers) should be used as first line medication primarily for their prognostic benefits, and that CCAs need only be introduced if beta-blockers are not tolerated, contraindicated or ineffective. Despite this, there is a wealth of evidence from clinical trials that demonstrate equal antianginal efficacy for CCAs and beta-blockers. The presence of chronic @entity712 and prior @entity583 are clear indications for the use of beta-blockers in preference to CCAs for the treatment of @entity5749 . However, in @entity1 with both @entity5749 and @entity101 , second and third generation CCAs may offer prognostic benefits of similar magnitude to those provided by beta-blockers. Therefore, antianginal drug therapy must be tailored to the individual needs and comorbidities of each elderly @entity1 .
