Treatment Overview

Stable angina is a common symptom of underlying coronary artery disease, often experienced as chest pain, tightness, or discomfort that occurs predictably during physical exertion or stress. While the symptoms are temporary and typically resolve with rest or medication, living with the anticipation of pain can cause significant anxiety and limit everyday activities. Understanding that this pain is a signal that the heart muscle is temporarily starved of oxygen is the first step toward effective management.

Treatment for stable angina is crucial for two reasons: first, to relieve the symptoms so patients can maintain an active lifestyle, and second, and most importantly, to manage the underlying disease. By controlling the progression of plaque buildup (atherosclerosis) and reducing the risk of blood clots, medications directly lower the chance of suffering a heart attack or stroke. Treatment is always tailored to the individual, balancing the need for symptom relief with the management of co-existing conditions like high blood pressure or diabetes (American Heart Association, 2024).

Overview of treatment options for Stable Angina

The comprehensive management of stable angina involves a two-pronged medication strategy: acute relief and long-term risk reduction.

Medications are the cornerstone of care, but they are supported by aggressive lifestyle modifications, including dietary changes, regular exercise, and absolute smoking cessation. The overall goals are to reduce the heart’s workload and stop the progression of plaque that causes the blockages. While surgical procedures (like stenting or bypass surgery) may be necessary for very severe blockages, most patients rely on medication to stabilize their condition, often for a lifetime.

Medications used for Stable Angina

Medication therapy for stable angina includes several drug classes, each serving a distinct purpose in improving symptoms and lowering the risk of a major cardiac event.

For immediate relief of an ongoing attack, nitrates (nitroglycerin) are essential. They are fast-acting, rescue medications that relieve pain within minutes.

For long-term daily management, multiple drug classes are used:

  • Antiplatelet Agents: Low-dose aspirin is standard for nearly all patients. It reduces the stickiness of platelets in the blood, preventing the formation of clots that can block an artery and cause a heart attack.
  • Beta-Blockers: Medications like metoprolol or atenolol are primary choices to reduce the heart’s workload and oxygen demand. They decrease heart rate and blood pressure, making the heart more resilient during exertion.
  • Cholesterol-Lowering Drugs: Statins (e.g., atorvastatin, rosuvastatin) are used to lower LDL (“bad”) cholesterol, stabilize existing plaque, and slow the disease’s progression. Studies show that aggressive statin and antiplatelet therapy stabilizes plaques and significantly reduces the risk of future heart attacks.
  • Additional Antianginals: If symptoms persist, calcium channel blockers (e.g., amlodipine, diltiazem) or newer drugs like ranolazine may be added to further reduce the frequency of chest pain episodes.

How these medications work

These medications target the fundamental problems in stable angina: reduced blood flow and increased cardiac strain.

Nitrates work by relaxing smooth muscle in the walls of the blood vessels, causing them to widen (vasodilation). This effect increases blood flow to the heart and simultaneously lowers the pressure the heart must pump against, reducing its workload.

Beta-blockers block the effects of adrenaline and other stress hormones on the heart. This reduces the heart rate and force of contraction, which in turn decreases the amount of oxygen the heart muscle needs to perform any given activity.

Statins interfere with cholesterol production in the liver. By dramatically lowering circulating cholesterol, they help shrink fatty deposits in the artery walls and stabilize plaque surfaces, making them less likely to rupture and form a dangerous clot (National Heart, Lung, and Blood Institute, 2022).

Side effects and safety considerations

Side effects vary: Nitrates cause headache, flushing, and dizziness due to vasodilation; beta-blockers may cause fatigue, cold extremities, or sexual dysfunction; statins can cause muscle aches (report to provider).

Never abruptly stop antiplatelet agents or beta-blockers, as this risks a serious cardiac event. Warn patients: combining nitrates with PDE5 inhibitors (erectile dysfunction drugs) can cause a life-threatening blood pressure drop. Call 911 if chest pain is sudden, severe, or unrelieved by rescue nitroglycerin.

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

  1. American Heart Association. https://www.heart.org
  2. Mayo Clinic. https://www.mayoclinic.org
  3. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov
  4. MedlinePlus. https://medlineplus.gov

Medications for Stable Angina

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Stable Angina.

Found 5 Approved Drugs for Stable Angina

Procardia

Generic Name
NIFEdipine

Procardia

Generic Name
NIFEdipine
Form: Tablet, Capsule
Method of administration: Oral
FDA approval date: September 06, 1989
Classification: Dihydropyridine Calcium Channel Blocker
I. Vasospastic Angina Nifedipine Extended-Release Tablets, USP are indicated for the management of vasospastic angina confirmed by any of the following criteria: 1) classical pattern of angina at rest accompanied by ST segment elevation, 2) angina or coronary artery spasm provoked by ergonovine, or 3) angiographically demonstrated coronary artery spasm. In those patients who have had angiography, the presence of significant fixed obstructive disease is not incompatible with the diagnosis of vasospastic angina, provided that the above criteria are satisfied. Nifedipine Extended-Release Tablets, USP may also be used where the clinical presentation suggests a possible vasospastic component, but where vasospasm has not been confirmed, e.g., where pain has a variable threshold on exertion, or in unstable angina where electrocardiographic findings are compatible with intermittent vasospasm, or when angina is refractory to nitrates and/or adequate doses of beta blockers. II. Chronic Stable Angina (Classical Effort-Associated Angina) Nifedipine Extended-Release Tablets, USP are indicated for the management of chronic stable angina (effort-associated angina) without evidence of vasospasm in patients who remain symptomatic despite adequate doses of beta blockers and/or organic nitrates or who cannot tolerate those agents. In chronic stable angina (effort-associated angina), nifedipine has been effective in controlled trials of up to eight weeks duration in reducing angina frequency and increasing exercise tolerance, but confirmation of sustained effectiveness and evaluation of long-term safety in these patients is incomplete. Controlled studies in small numbers of patients suggest concomitant use of nifedipine and beta-blocking agents may be beneficial in patients with chronic stable angina, but available information is not sufficient to predict with confidence the effects of concurrent treatment, especially in patients with compromised left ventricular function or cardiac conduction abnormalities. When introducing such concomitant therapy, care must be taken to monitor blood pressure closely, since severe hypotension can occur from the combined effects of the drugs. III. Hypertension Nifedipine Extended-Release Tablets, USP are indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including Nifedipine Extended-Release Tablets, USP. Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than one drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC). Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly. Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal. Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy. Nifedipine Extended-Release Tablets, USP may be used alone or in combination with other antihypertensive agents.

Verapamil

Brand Names
Verapamil HCI, Trandolapril, Verelan

Verapamil

Brand Names
Verapamil HCI, Trandolapril, Verelan
Form: Injection, Tablet, Capsule
Method of administration: Oral, Intravenous
FDA approval date: October 01, 1986
Classification: Angiotensin Converting Enzyme Inhibitor
Verapamil hydrochloride injection, USP is indicated for the following: Rapid conversion to sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory bypass tracts (Wolff-Parkinson-White [W-P-W] and Lown-Ganong- Levine [L-G-L] syndromes). When clinically advisable, appropriate vagal maneuvers (e.g., Valsalva maneuver) should be attempted prior to verapamil hydrochloride administration. Temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation except when the atrial flutter and/or atrial fibrillation are associated with accessory bypass tracts (Wolff-Parkinson-White (W-P-W) and Lown-Ganong-Levine (L-G-L) syndromes). In controlled studies in the United States, about 60% of patients with supraventricular tachycardia converted to normal sinus rhythm within 10 minutes after intravenous verapamil hydrochloride. Uncontrolled studies reported in the world literature describe a conversion rate of about 80%. About 70% of patients with atrial flutter and/or fibrillation with a faster ventricular rate respond with a decrease in ventricular rate of at least 20%. Conversion of atrial flutter or fibrillation to sinus rhythm is uncommon (about 10%) after verapamil hydrochloride and may reflect the spontaneous conversion rate, since the conversion rate after placebo was similar. Slowing of the ventricular rate in patients with atrial fibrillation/flutter lasts 30 to 60 minutes after a single injection. Because a small fraction (<1.0%) of patients treated with verapamil hydrochloride respond with life-threatening adverse responses (rapid ventricular rate in atrial flutter/fibrillation and an accessory bypass tract, marked hypotension, or extreme bradycardia/asystole-see CONTRAINDICATIONS and WARNINGS ), the initial use of verapamil hydrochloride injection should, if possible, be in a treatment setting with monitoring and resuscitation facilities, including D.C.-cardioversion capability. As familiarity with the patient's response is gained, use in an office setting may be acceptable. Cardioversion has been used safely and effectively after verapamil hydrochloride injection.

Diltiazem

Brand Names
Matzim, Cardizem, Tiadylt, Tiazac, Cartia XT, Diltiazem HCI

Diltiazem

Brand Names
Matzim, Cardizem, Tiadylt, Tiazac, Cartia XT, Diltiazem HCI
Form: Injection, Tablet, Capsule
Method of administration: Oral, Intravenous
FDA approval date: November 05, 1992
Classification: Calcium Channel Blocker
Diltiazem Hydrochloride Extended-Release Tablet is a nondihydropyridine calcium channel blocker indicated for: treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. It can be used alone or in combination with other antihypertensives.

Atorvastatin

Brand Names
Lipitor, Lotrel, Katerzia, Amlodipine, Benazepril, Amlodipine Besylate, Azor, Caduet, Norliqva, Atorvaliq, Lotensin, Olmesartan Medoxomil, Benicar, Tribenzor, Olmesartan Medoxomil Amlodipine, Norvasc

Atorvastatin

Brand Names
Lipitor, Lotrel, Katerzia, Amlodipine, Benazepril, Amlodipine Besylate, Azor, Caduet, Norliqva, Atorvaliq, Lotensin, Olmesartan Medoxomil, Benicar, Tribenzor, Olmesartan Medoxomil Amlodipine, Norvasc
Form: Tablet, Suspension, Capsule, Solution
Method of administration: Oral
FDA approval date: June 21, 1991
Classification: HMG-CoA Reductase Inhibitor
Atorvastatin calcium tablets are indicated: To reduce the risk of: Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD MI and stroke in adults with type 2 diabetes mellitus with multiple risk factors for CHD but without clinically evident CHD Non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for congestive heart failure, and angina in adults with clinically evident CHD As an adjunct to diet to reduce low-density lipoprotein cholesterol (LDL-C) in: Adults with primary hyperlipidemia. Adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (HeFH). As an adjunct to other LDL-C-lowering therapies, or alone if such treatments are unavailable, to reduce LDL-C in adults and pediatric patients aged 10 years and older with homozygous familial hypercholesterolemia (HoFH). As an adjunct to diet for the treatment of adults with: Primary dysbetalipoproteinemia Hypertriglyceridemia Atorvastatin calcium is an HMG-CoA reductase inhibitor (statin) indicated ( 1 ): To reduce the risk of: Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD. MI and stroke in adults with type 2 diabetes mellitus with multiple risk factors for CHD but without clinically evident CHD. Non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for congestive heart failure, and angina in adults with clinically evident CHD. As an adjunct to diet to reduce low-density lipoprotein (LDL-C) in: Adults with primary hyperlipidemia. Adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (HeFH). As an adjunct to other LDL-C-lowering therapies to reduce LDL-C in adults and pediatric patients aged 10 years and older with homozygous familial hypercholesterolemia. As an adjunct to diet for the treatment of adults with: Primary dysbetalipoproteinemia. Hypertriglyceridemia.

Cardene

Generic Name
Nicardipine

Cardene

Generic Name
Nicardipine
Form: Injection, Capsule
Method of administration: Oral, Intravenous
FDA approval date: January 30, 1992
Classification: Dihydropyridine Calcium Channel Blocker
Nicardipine hydrochloride injection USP is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible.
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