Nicardipine treatment has been evaluated in patients with chronic stable effort angina or with angina at rest due to coronary spasm. Acute studies in patients with effort angina suggest a very favorable hemodynamic profile characterized by coronary vasodilatation and reduction in determinants of myocardial oxygen demand. Both open and controlled trials in patients with effort angina show that long-term oral administration increases exercise time and time to onset of 1 mm ST-segment depression and decreases angina frequency. With treatment for up to 6 months, antiischemic effects were maintained without serious adverse reactions. Other studies indicate that nicardipine is generally comparable to propranolol and nifedipine in prolonging exercise time and time to onset of ST-segment depression. Nicardipine, however, does not depress heart rate at rest, and maximal exercise workload is higher with nicardipine than with either placebo or propranolol. In a controlled study of patients with angina at rest due to coronary spasm, nicardipine decreased angina frequency and nitroglycerin consumption by approximately 80%. Episodes of symptomatic and asymptomatic ST-segment shift, as recorded by ambulatory electrocardiographic monitoring, showed a trend to decrease in number. Nicardipine appeared similarly effective in patients with coronary spasm superimposed on significant coronary disease and with spasm in the absence of significant coronary disease. Nicardipine appears to be safe and effective in the management of patients with angina pectoris.