Which class of medication is first-line in managing angina?

Beta-blockers are the first-line medication for managing angina due to their effectiveness in reducing myocardial oxygen demand and improving exercise tolerance. They achieve this by lowering heart rate, decreasing contractility, and reducing blood pressure, which collectively relieve the symptoms of angina by preventing the heart from working too hard.

The use of beta-blockers has been well-established in numerous clinical guidelines and studies as they not only alleviate angina symptoms but also provide additional cardiovascular protection. They can improve long-term outcomes in patients with ischemic heart disease.

Calcium channel blockers can also be used in the management of angina, particularly in patients who may not tolerate beta-blockers or need additional control. Long-acting nitrates can provide symptomatic relief as well, but they are typically not first-line treatments given the risk of tolerance over time. ACE inhibitors are primarily used for managing blood pressure and heart failure, and while they can be beneficial in certain populations with coronary artery disease, they are not a direct treatment for angina itself.