Alternatives to beta-blockade in therapy of hypertension with angina pectoris: role of nifedipine or of labetalol.

1 Patients with combined hypertension and angina pectoris may represent a therapeutic dilemma, with the angina being refractory to conventional beta-blockade. 2 The added benefit of peripheral vasodilation in control of blood pressure is documented in the case of nifedipine. 3 Improved blood pressure control by added nifedipine may not be accompanied by decreased severity of angina pectoris, emphasizing the complex causation of the angina in such patients. 4 The clinically proven added alpha-blocking activity of labetalol distinguishes labetalol from other beta-blockers. However, the suggested benefits of the added alpha-activity in patients with hypertension and angina remain to be proven by further trials in patients.