What is the most appropriate antianginal therapy for a patient with stable angina and significant COPD where beta-blockers are contraindicated?

• A. Amlodipine
• B. Lisinopril
• C. Propranolol
• D. Ranolazine

Answer: (A)

In stable angina, reducing the heart’s oxygen demand is key. Beta-blockers do that effectively, but significant COPD makes beta-blockade risky because it can cause bronchospasm or worsen dyspnea, and even cardioselective options aren’t ideal in severe disease. A dihydropyridine calcium channel blocker like amlodipine relaxes vascular smooth muscle, lowering afterload and myocardial oxygen demand, which helps relieve angina without triggering bronchospasm. That safety profile in COPD, combined with its antianginal effect, makes amlodipine the best choice here. Lisinopril isn’t an antianginal agent, propranolol would worsen COPD, and ranolazine can be useful especially when beta-blockers aren’t tolerated but is typically considered after first optimizing you with a calcium channel blocker.