Steps for stable angina management in primary care, including first-line anti-an

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 ¹.

First-line anti-anginal medications include a beta blocker or a calcium channel blocker, chosen based on comorbidities, contraindications, and patient preference ¹.

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 ¹.

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 ¹.

For secondary prevention, consider aspirin 75 mg daily, ACE inhibitors in diabetics, statins, and blood pressure control, as appropriate ¹.

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 ¹.

Patients should be advised to use short-acting nitrates for symptom relief, with instructions on administration, repeat dosing, and when to seek emergency care ¹.