UWorld Internal Medicine Practice Test

In the management of chronic stable angina, beta-blockers are considered first-line therapy due to their ability to effectively reduce myocardial oxygen demand. They achieve this by lowering heart rate, decreasing contractility, and reducing blood pressure, which collectively help alleviate angina symptoms. Clinical guidelines have consistently supported the use of beta-blockers as the initial pharmacological treatment for patients experiencing chronic stable angina, particularly in those with a history of myocardial infarction or other forms of cardiovascular disease.

Nitrates, while effective at relieving acute angina symptoms, are generally not used as first-line therapy for chronic management due to issues related to tolerance and the need for dosing strategies to avoid daily tolerance build-up. Calcium channel blockers can also be effective, especially in patients who may not tolerate beta-blockers, but they are typically not the first choice. Antiplatelet agents are essential for secondary prevention in patients with a history of coronary artery disease but do not directly improve symptoms of angina or reduce the frequency of angina episodes as primary therapy does.

Thus, the comprehensive understanding of how beta-blockers function in the context of chronic stable angina supports their designation as the first-line medication in this setting.