From the Guidelines
The management of angina should prioritize a personalized approach, considering the patient's comorbidities and the underlying mechanism of disease, with the goal of relieving symptoms, improving quality of life, and reducing cardiovascular risk. This approach is supported by the expert consensus document published in Nature Reviews Cardiology in 2018 1. The treatment of angina has two main goals: to alleviate symptoms and improve quality of life, and to prevent cardiovascular events, mainly myocardial infarction and death, as stated in the expert consensus document published in Nature Reviews Cardiology in 2018 1.
Key Components of Angina Management
- Lifestyle modifications, such as smoking cessation, regular exercise, weight management, and a heart-healthy diet, are essential for managing angina.
- Medication therapy typically begins with sublingual nitroglycerin (0.3-0.6 mg) for acute symptom relief, which can be taken as needed when chest pain occurs.
- For long-term management, beta-blockers like metoprolol (25-200 mg daily) or atenolol (25-100 mg daily) are often prescribed as first-line agents to reduce heart rate and blood pressure, decreasing myocardial oxygen demand, as recommended by the American College of Physicians in 2004 1.
- Calcium channel blockers such as amlodipine (5-10 mg daily) or diltiazem (120-360 mg daily) are alternatives for patients who cannot tolerate beta-blockers.
- Long-acting nitrates like isosorbide mononitrate (30-120 mg daily) help prevent angina attacks by dilating blood vessels.
- Antiplatelet therapy with aspirin (75-100 mg daily) is recommended to reduce thrombotic risk, as stated in the study published in Annals of Internal Medicine in 2004 1.
Personalized Approach to Angina Treatment
The expert consensus document published in Nature Reviews Cardiology in 2018 1 proposes an individualized approach to angina treatment, which takes into consideration the patient, their comorbidities, and the underlying mechanism of disease. This approach is essential for optimizing treatment outcomes and improving patient quality of life. A combination of two or more anti-ischaemic drugs with additive or synergistic effects is often needed to control symptoms effectively, as stated in the expert consensus document published in Nature Reviews Cardiology in 2018 1.
Revascularization Procedures
In cases where medical therapy fails to control symptoms, revascularization procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) may be necessary, as recommended by the expert consensus document published in Nature Reviews Cardiology in 2018 1. These treatments work by addressing the underlying imbalance between myocardial oxygen supply and demand, either by decreasing demand (beta-blockers, lifestyle changes) or increasing supply (nitrates, revascularization).
From the FDA Drug Label
By blocking catecholamine-induced increases in heart rate, in velocity and extent of myocardial contraction, and in blood pressure, metoprolol reduces the oxygen requirements of the heart at any given level of effort, thus making it useful in the long-term management of angina pectoris
- Management of Angina: Metoprolol is used in the long-term management of angina pectoris by reducing the oxygen requirements of the heart.
- The drug works by blocking catecholamine-induced increases in heart rate, velocity and extent of myocardial contraction, and blood pressure.
- Key Benefits: Reduces the number of angina attacks and increases exercise tolerance 2.
- Dosage: The oral dosage used in studies ranged from 100 to 400 mg daily 2.