Heart rate reduction is a well accepted and effective approach for the prevention of angina pectoris. Ivabradine is the first selective and specific inhibitor of the I(f) current and provides pure heart rate reduction without altering myocardial contractility. Clinical evidence of the antianginal and anti-ischaemic efficacy and tolerability of ivabradine comes from the largest clinical development programme that has ever been performed in stable angina pectoris, involving more than 5000 patients. Ivabradine at the dosages of 5 or 7.5mg twice daily is as effective as reference antianginal approaches such as beta-adrenoceptor antagonists and calcium channel antagonists. The clinical efficacy and safety of ivabradine has also been confirmed in a 1-year follow-up study. Ivabradine is well tolerated and free from the most commonly observed adverse effects of currently prescribed antianginal drugs. Visual symptoms can occur in a minority of patients treated with ivabradine and are not associated with structural ocular changes. The ongoing clinical development programme with the two major morbidity-mortality studies, BEAUTIFUL and SHIfT, has the potential to greatly extend the use of ivabradine in patients with coronary artery disease as well as in those with heart failure.