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Beta blockers are a group of drugs that affect heart contractility, or the ability of the heart to contract. They are used to treat angina pectoris, which is due to inadequate blood flow to the heart and results in constricting chest pain. However, these drugs can not be given to angina patients who have certain other cardiovascular problems or asthma. This study examined the effectiveness of the new beta blocker esmolol in treating angina patients with problems that would normally prevent their receiving beta blockers. Esmolol is given by injection and acts very quickly. It was thought that this drug could be used for this patient population because it is rapidly metabolized. The study involved 113 patients with unstable angina, or severe chest pain that occurs frequently, even at rest. Fifty-nine patients were given esmolol, and the other 54 received an inactive placebo. Results showed that esmolol significantly lowered heart rate and blood pressure. A significant clinical cardiovascular event occurred in 9 of the placebo subjects (17 percent), but in only 3 of the esmolol subjects (5 percent). Symptoms of angina were experienced by 18 of the patients receiving esmolol (30 percent) and 23 of the placebo patients (43 percent). Silent ischemia (periods when the heart was not receiving an adequate blood supply, but no symptoms occurred) was detected in 18 of the esmolol patients (35 percent) and 17 of the placebo patients (36 percent). The overall occurrence of ischemia was 54 percent in the esmolol group and 60 percent in those given the placebo. Adverse effects were reported by 39 percent of the esmolol patients and 22 percent of the placebo group. These findings indicate that esmolol can significantly decrease heart rate and blood pressure in patients with angina pectoris. It also tends to relieve the symptoms of the disease. As a fast-acting drug, esmolol may be safe and effective in the population of angina patients who do not usually benefit from beta blockers. (Consumer Summary produced by Reliance Medical Information, Inc.)