This article studies the different methods of antianginal drug evaluation in the long-term treatment of ischemic heart disease. Subjective and objective methods are discussed with their limitations. The authors review serial ECG stress testing, this being the most frequently used method of antianginal pharmacotherapy evaluation. Safety, selected topics related to bioethics and statistical analysis in the clinical evaluation of drugs are discussed. Meta-analyses and clinical multicenter mega-trials, which are currently gaining in popularity and are likely to play an important role in the complex process of therapeutic decision making in the future, are discussed in the final section of this paper.