دانلود کتاب دارودرمانی قلب و عروق – راهکارهای مبتنی بر شواهد برای طبابت بالینی

Current guidelines on both sides of the Atlantic Ocean still recommend beta-blockers or calciumchannel blockers as first-line agents and long-acting nitrates, ivabradine, ranolazine or trimetazidine as second-line drugs24,25. A consensus document by ANMCO/GICR-IACPR/SICI-GISE considers beta-blockers first-line antianginal drugs, assigning ranolazine and ivabradine to the second line in case of inefficacy or intolerance to beta-blockers and relegating calcium-channel blockers, long-acting nitrates and trimetazidine to the third line26. Finally, the 2019 ESC Guidelines consider four steps in the selection of antianginal treatment, keeping beta-blockers or calciumchannel blockers as the first-step agents and leaving the second, third and fourth steps to the new generation of drugs1. It is important to note that this stepwise approach is based more on tradition and expert opinion rather than evidence. Moreover, this strategy does not address the variable pathophysiology of ischemic syndromes and the variety of patient phenotypes. The stepwise strategy should be replaced by a tailored approach to the selection of antianginal therapy, which takes into account:
1 The multifactorial pathophysiology of individual ischemic syndrome.
2 The differential pharmacology of antianginal drugs and their combination properties.
3 The clinical setting and patient comorbidities.