Currently therapy for ischaemic heart disease is based on drugs such as beta-adrenoceptor antagonists, Ca2+ antagonists and nitrates, which have pronounced haemodynamic effects. However, these drugs can have adverse reactions including systemic haemodynamic effects, leading to low blood pressure and peripheral oedema in some patients. Recent observations that certain types of Ca2+ antagonist prevent the Ca2+ overload that occurs after ischaemia have led to the design of new anti-ischaemic drugs that are cytoprotective, but have no (or few) haemodynamic effects. In this article, Pieter van Zwieten and colleagues assess the therapeutic potential of these drugs.