Treatment to prevent angina

Knuuti, 2020National Institute for Health and Care Excellence (NICE), 2011 [Last updated 2016]

Treatment to prevent angina aims to reduce myocardial oxygen demand, and increase oxygen supply and exercise tolerance. Optimal treatment of underlying coronary artery disease adds to the effectiveness of antianginal therapiesOhman, 2016; in particular, treatment with aspirin and a statin (see Secondary prevention of atherosclerotic cardiovascular events) and treatment of elevated blood pressure (see Hypertension and blood pressure reduction).

Treat angina with a single antianginal therapy initially. If this is not adequate, treat with a combination of 2 antianginal therapies from different classes (beta blockers, dihydropyridine calcium channel blockers or long-acting nitrates). If a beta blocker is contraindicated, it may be replaced by a nondihydropyridine calcium channel blocker. The choice of drug depends on the patient’s comorbidities and the adverse effects of the drug.