In primary care, the management of stable angina involves diagnosing the condition based on clinical assessment and risk factors, and providing patient education about the condition, triggers, and treatment options NICE CG126.
First-line anti-anginal medications include a beta blocker or a calcium channel blocker, chosen based on comorbidities, contraindications, and patient preference NICE CG126.
If symptoms are not controlled, consider switching between these two classes or using a combination of a dihydropyridine calcium channel blocker with a beta blocker NICE CG126.
Additional monotherapy options for those intolerant or contraindicated to first-line drugs include a long-acting nitrate, ivabradine, nicorandil, or ranolazine, with decisions guided by comorbidities, contraindications, preferences, and costs NICE CG126.
For secondary prevention, consider aspirin 75 mg daily, ACE inhibitors in diabetics, statins, and blood pressure control, as appropriate NICE CG126.
Referral for revascularisation (CABG or PCI) is considered if symptoms are not satisfactorily controlled with optimal medical therapy, especially if coronary anatomy indicates left main stem disease or proximal three-vessel disease NICE CG126.
Patients should be advised to use short-acting nitrates for symptom relief, with instructions on administration, repeat dosing, and when to seek emergency care NICE CG126.