[Heart rate as a therapeutic target for stable angina. Role of anti-ischemic agents and their underuse in Italy].

Several epidemiological studies showed that heart rate is associated with a high morbidity and mortality rate in the general population and in subjects affected by different cardiovascular diseases. Particularly relevant is the role of heart rate in patients with stable angina, a clinical condition that affects mainly 40 000 patients per one million people. The treatment of stable angina is focused more on symptom improvement than on decrease of mortality. In this context, beta-blockers are usually recommended for these patients, since, reducing heart rate and blood pressure, favorably influence clinical symptoms. However, data from registries show that nearly one third of patients with stable angina do not receive beta-blockers for specific contraindications or intolerance. For these patients, new perspectives of treatment might be available with the use of a new class of drugs, the inhibitors of the I(f) channels, which selectively reduce heart rate without interfering with other pathophysiological mechanisms.