What are the current guidelines for the management of stable angina in primary care?

Diagnose stable angina according to NICE guidelines on recent-onset chest pain of suspected cardiac origin, and manage it based on the best available evidence ¹.

Provide clear information and support to the person, including factors that provoke angina (such as exertion, emotional stress, cold exposure, heavy meals), and discuss its long-term course and management ¹,³.

Encourage questions, address misconceptions, and involve family or carers when relevant ¹,³.

Advise seeking professional help if there is a sudden worsening of angina symptoms ¹.

Discuss the purpose, risks, and benefits of treatment, including lifestyle advice on exercise, smoking cessation, diet, and weight control ¹.

Offer a short-acting nitrate for immediate relief and prevention of angina episodes, instructing on its use and advising to call emergency services if pain persists after two doses ¹,³.

Consider starting or continuing aspirin 75 mg daily for secondary prevention, taking into account bleeding risk ¹.

Consider ACE inhibitors for people with diabetes and offer or continue them for other conditions like hypertension or heart failure ¹.

Offer statin treatment in line with NICE lipid modification guidelines ¹.

Offer treatment for high blood pressure according to NICE hypertension guidelines ¹.

Do not offer vitamin or fish oil supplements for stable angina, as there is no evidence of benefit ¹.

Use optimal drug treatment, typically one or two anti-anginal drugs plus secondary prevention medications, aiming to prevent angina episodes and cardiovascular events ¹.

Review response and side effects 2–4 weeks after starting or changing treatment, titrating doses as needed ¹.

Refer for revascularization if symptoms are poorly controlled despite maximum tolerated doses of two drugs or if there is evidence of extensive ischemia ¹.