ACE inhibitors
Angiotensin-converting enzyme inhibitors, such as captopril (Capoten) and enalapril (Vasotec), along with many others, are a recent class of drugs used in the treatment of coronary heart disease. Research shows they extend life and reduce the chances of heart failure after heart attack. They act by preventing angiotensin from causing constriction of smaller arteries, which reduces “afterload” and allows the heart to work less hard. They also treat hypertension as do beta-blockers and calcium antagonists. Side effects include low blood pressure, kidney dysfunction, and more minor problems such as persistent cough, taste alterations, and rash.
Aspirin
No review of drugs used for angina would be complete without a mention of aspirin. In these circumstances, aspirin is not being prescribed for its well-known effect on pain, but for its effect on the platelets in the bloodstream. In low doses—half a standard aspirin tablet per day—aspirin prevents platelets from sticking together or from adhering to the surface of atheromatous plaques.
As this is the first step to thrombosis at the site of a plaque, aspirin should, in theory, prevent the thromboses within the coronary arteries at stenotic sites that are thought to be the main cause of heart attacks. The whole medical world now accepts, after many trials have shown its effects, that one aspirin should be given at the time of an acute heart attack to minimize the damage, and thereafter to prevent a further attack.
It is a very small step from giving such a low dose of aspirin during a heart attack to its use to prevent one in people with angina. I advise all my patients with angina to take half an aspirin a day. The very .few who cannot tolerate this dose of the drug because it gives them indigestion may have to do without it, but it is possibly a lifesaver for the rest. It has no obvious effect on the angina, but it may well prevent the angina from becoming a full-blown heart attack.
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