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: smoking cessation, regular exercise, weight management, and a heart-healthy diet
- First-line medication therapy: nitrates like sublingual nitroglycerin (0.3-0.6 mg) for acute symptom relief, beta-blockers (such as metoprolol 25-100 mg twice daily or atenolol 25-100 mg daily), and calcium channel blockers like amlodipine (5-10 mg daily) or diltiazem (120-360 mg daily)
- Antiplatelet therapy: aspirin (75-100 mg daily) to prevent thrombotic events
- Risk factor management: statins for cholesterol control, antihypertensives if needed, and diabetes management
- Revascularization procedures: percutaneous coronary intervention or coronary artery bypass grafting for refractory angina or significant coronary artery disease
Personalized Approach
The expert consensus document published in Nature Reviews Cardiology in 2018 1 proposes an individualized approach to angina treatment, taking into consideration the patient, their comorbidities, and the underlying mechanism of disease. This approach is supported by the fact that patients with angina can have several comorbidities, and symptoms can result from various underlying pathophysiologies.
Combination Therapy
Combination therapy with 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. The choice of combination therapy should be tailored to the type of chronic stable angina and to the individual patient.
Regular Follow-up
Regular follow-up is essential to assess treatment effectiveness and adjust therapy as needed, as stated in the example answer. This is crucial to ensure that the patient's symptoms are well-controlled, and their cardiovascular risk is minimized.
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 In controlled clinical trials, metoprolol, administered orally two or four times daily, has been shown to be an effective antianginal agent, reducing the number of angina attacks and increasing exercise tolerance.
The management of angina involves the use of metoprolol, a beta 1-selective (cardioselective) adrenergic receptor blocker, to reduce the oxygen requirements of the heart. This is achieved by blocking catecholamine-induced increases in heart rate, velocity and extent of myocardial contraction, and in blood pressure.
- The oral dosage of metoprolol used in clinical studies for angina ranged from 100 to 400 mg daily.
- Metoprolol has been shown to be an effective antianginal agent, reducing the number of angina attacks and increasing exercise tolerance 2.