What is the first-line therapy for Prinzmetal angina?

Prinzmetal angina, also known as variant angina, is caused by coronary artery spasm that leads to transient ischemic episodes. The main therapeutic goal is to relieve the spasms of the coronary arteries and improve blood flow to the heart.

Calcium channel blockers are the first-line therapy for Prinzmetal angina because they are effective in relaxing and dilating the smooth muscle of the coronary arteries, thus preventing or reducing the frequency of the spasms that characterize this condition. By inhibiting the influx of calcium ions into vascular smooth muscle cells, these medications decrease vascular resistance and improve myocardial oxygen supply.

Nitrates can also be used to relieve acute episodes of angina by causing vasodilation, but their use is often limited due to the potential development of tolerance with prolonged use. Beta-blockers are generally avoided in this condition, as they may exacerbate coronary vasospasm in some patients. ACE inhibitors are primarily used for other cardiovascular conditions such as heart failure and hypertension but are not specific to treating Prinzmetal angina.

Given these considerations, calcium channel blockers are recognized as the most effective and appropriate first-line treatment strategy for managing this form of angina.