In stable angina, what is the first-line antianginal agent for symptom control?

• A. Calcium channel blocker
• B. Nitrate
• C. ACE inhibitor
• D. Beta-blocker (e.g., metoprolol)

Answer: (D)

Controlling symptoms in stable angina centers on lowering the heart’s oxygen demand during activity. A beta-blocker achieves this best because it slows the heart rate, reduces myocardial contractility, and lowers blood pressure. By dialing down heart rate and contractility, the heart needs less oxygen, and with a longer diastolic interval, coronary perfusion improves. This combination tends to delay the onset of angina during exertion and Improve exercise tolerance, making it the most effective first-line option for symptom control.

Nitrates act quickly to relieve pain by dilating veins and reducing preload, but they don’t prevent angina on ongoing activity the way a preventive agent does. Calcium channel blockers also help, either by reducing afterload (and in non-dihydropyridine types, by lowering heart rate and contractility), but when possible, starting with a beta-blocker provides more consistent baseline control during daily activities. ACE inhibitors aren’t antianginal agents; they’re used for血 pressure control and comorbidity management, not symptom control of angina.