Comparative Study of Efficacy and Safety of Ivabradine Versus Metoprolol in Stable Angina

Background: Stable angina pectoris, a manifestation of coronary artery disease (CAD), remains a major cause of morbidity worldwide, with India bearing a disproportionately high burden. Beta-blockers such as metoprolol are established first-line agents, but their use may be limited by adverse effects. Ivabradine, a selective If channel inhibitor, reduces heart rate without affecting contractility or blood pressure, offering a potential therapeutic alternative. Methods: This prospective, randomized, open-label clinical trial enrolled 100 patients aged 35–70 years with CCS class II–III stable angina and CAD. Participants were randomized to receive either ivabradine (5–7.5 mg twice daily) or metoprolol succinate (50–100 mg once daily) for six months, alongside standard background therapy. The primary endpoint was reduction in resting heart rate at four months. Secondary endpoints included frequency of angina attacks, nitroglycerin consumption, CCS classification, and incidence of adverse events. Results: Both groups were comparable at baseline. Ivabradine demonstrated a significantly greater reduction in angina attacks at 3 months (0.57 vs. 1.09 attacks/week, p<0.0001) and a trend towards superiority at 6 months (0.23 vs. 0.31 attacks/week, p=0.0508). A higher proportion of ivabradine patients achieved CCS class I (74% vs. 58%). Fatigue was significantly more frequent with metoprolol (20% vs. 4%, p=0.0277). Both drugs reduced resting heart rate, with a greater decline observed in the ivabradine group. Conclusion: Ivabradine monotherapy was non-inferior and potentially superior to metoprolol in reducing angina burden and nitroglycerin use, with a favorable tolerability profile. Keywords: Stable angina; coronary artery disease; Ivabradine; Metoprolol; Heart rate reduction; Antianginal therapy