Stable Angina: When Beta-Blocker and DHP-CCB Therapy Fails to Control Symptoms
This protocol addresses stable angina that remains inadequately controlled after a first-line combination regimen — guiding the next treatment step toward adequate relief of angina symptoms.
Previous therapy — goal not reached
A combination of a beta-blocker and a dihydropyridine CCB (DHP-CCB) was used — with long-acting nitrates or ranolazine as alternatives or additions — and failed to achieve adequate control and relief of angina symptoms.
Next-step approach (partial)
Add-on antianginal therapy is considered, with the choice of agent informed by the patient's cardiac profile — the complete evidence-based regimen and selection criteria are in the full protocol.
References
- Nicorandil or trimetazidine may be considered as add-on therapy in patients with inadequate control of symptoms while on treatment with beta-blockers and/or CCBs, or as part of initial treatment in properly selected patients.
- Ivabradine should be considered as add-on antianginal therapy in patients with left ventricular systolic dysfunction (LVEF <40%) and inadequate control of symptoms, or as part of initial treatment in properly selected patients.
DOI: 10.1093/eurheartj/ehae177
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