CHAPTER 23
CARDIOVASCULAR DRUGS
LAWRENCE S. COHEN, M.D., LAWRENCE DECKELBAUM, M.D., JONATHAN ISAACSOHN, M.D., FORRESTER A. LEE, M.D., CRAIG A. McPHERSON, M.D., MARVIN MOSER, M.D., and LYNDA E. ROSENFELD, M.D.
INTRODUCTION
When people are diagnosed with heart disease, they may be treated in several different ways. Controlling risk factors that can be managed—cutting down on fat and cholesterol and quitting smoking—will be the first changes they will have to make. (See Chapter 3.) Exercise will become part of their lives, if possible. Drug therapy may be the next course of action. The variety and scope of cardiovascular drugs have increased tremendously in the past few decades, and new drugs are being approved annually. in the 1950s, effective oral diuretics became available. These drugs dramatically changed the treatment of heart failure and hypertension. In the mid-1960s a class of agents called beta blockers was discovered. This led to major changes in physicians’ ability to treat patients with hypertension or angina pectoris. Calcium channel blockers and ACE inhibitors became widely used in the 1980s, and they, too, have allowed patients with hypertension, heart failure, and coronary artery disease to be treated more effectively. The development and use of thrombolytics, the “clot busters,” have revolutionized our ability to treat patients having a heart attack.
The decade of the 1990s holds even greater promise as the powerful tools of genetic engineering produce new and even more effective drugs to prevent and treat patients with heart disease. Initially, a person on drug therapy may have to try different drugs to find the one that is the most effective and has the fewest side effects. People with other health problems or physical characteristics may find one type of drug to be more useful than another. (See box, “Factors in Choosing Certain Cardiovascular Drugs.”) More than one drug may be used at a time. Once a dose has been established,...