scholarly journals Stable Angina Medical Therapy Management Guidelines: A Critical Review of Guidelines from the European Society of Cardiology and National Institute for Health and Care Excellence

2019 ◽  
Vol 14 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Talla A Rousan ◽  
Udho Thadani
Keyword(s):  
European Society ◽  
Stable Angina ◽  
Beta Blockers ◽  
Stable Coronary Artery Disease ◽  
Lifestyle Changes ◽  
Channel Blockers ◽  
First Line ◽  
Antianginal Drugs ◽  
European Society Of Cardiology ◽  
Randomised Controlled

Most patients with stable angina can be managed with lifestyle changes, especially smoking cessation and regular exercise, along with taking antianginal drugs. Randomised controlled trials show that antianginal drugs are equally effective and none of them reduced mortality or the risk of MI, yet guidelines prefer the use of beta-blockers and calcium channel blockers as a first-line treatment. The European Society of Cardiology guidelines for the management of stable coronary artery disease provide classes of recommendation with levels of evidence that are well defined. The National Institute for Health and Care Excellence (NICE) guidelines for the management of stable angina provide guidelines based on cost and effectiveness using the terms first-line and second-line therapy. Both guidelines recommend using low-dose aspirin and statins as disease-modifying agents. The aim of this article is to critically appraise the guidelines’ pharmacological recommendations for managing patients with stable angina.

Chronic stable angina

2019 ◽  
pp. 91-106
Author(s):  
Gaetano Antonio Lanza ◽  
Antonio De Vita
Keyword(s):  
Stable Angina ◽  
Myocardial Oxygen Consumption ◽  
Beta Blockers ◽  
Chronic Stable Angina ◽  
Pharmacological Therapy ◽  
Lifestyle Changes ◽  
Channel Blockers ◽  
Variable Combination ◽  
Improve Clinical Outcome ◽  
Risk Factor Burden

Treatment of patients with chronic stable angina has two main objectives: to improve clinical outcome and to reduce angina symptoms. Prognosis is mainly improved by a reduction in cardiovascular risk factor burden, which may be achieved by appropriate lifestyle changes and, for some risk factors (e.g. hypercholesterolaemia, hypertension, diabetes), appropriate pharmacological therapy (including, in particular, statins and renin–angiotensin–aldosterone system inhibitors) and use of antithrombotic agents. Symptoms can be improved by a variable combination of traditional (beta-blockers, calcium channel blockers, nitrates) and novel (e.g. ivabradine, ranolazine) anti-ischaemic drugs, which may act through reduction in myocardial oxygen consumption and/or improvement of myocardial perfusion.

scholarly journals Anti-anginal drugs–beliefs and evidence: systematic review covering 50 years of medical treatment

2018 ◽  
Vol 40 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Roberto Ferrari ◽  
Rita Pavasini ◽  
Paolo G Camici ◽  
Filippo Crea ◽  
Nicolas Danchin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Beta Blockers ◽  
Stable Coronary Artery Disease ◽  
Chronic Stable Angina ◽  
Cochrane Collaboration ◽  
Pharmacological Therapy ◽  
Channel Blockers ◽  
Second Line ◽  
First Line ◽  
Double Blind

Abstract Chronic stable angina is the most prevalent symptom of ischaemic heart disease and its management is a priority. Current guidelines recommend pharmacological therapy with drugs classified as being first line (beta blockers, calcium channel blockers, short acting nitrates) or second line (long-acting nitrates, ivabradine, nicorandil, ranolazine, and trimetazidine). Second line drugs are indicated for patients who have contraindications to first line agents, do not tolerate them or remain symptomatic. Evidence that one drug is superior to another has been questioned. Between January and March 2018, we performed a systematic review of articles written in English over the past 50 years English-written articles in Medline and Embase following preferred reporting items and the Cochrane collaboration approach. We included double blind randomized studies comparing parallel groups on treatment of angina in patients with stable coronary artery disease, with a sample size of, at least, 100 patients (50 patients per group), with a minimum follow-up of 1 week and an outcome measured on exercise testing, duration of exercise being the preferred outcome. Thirteen studies fulfilled our criteria. Nine studies involved between 100 and 300 patients, (2818 in total) and a further four enrolled greater than 300 patients. Evidence of equivalence was demonstrated for the use of beta-blockers (atenolol), calcium antagonists (amlodipine, nifedipine), and channel inhibitor (ivabradine) in three of these studies. Taken all together, in none of the studies was there evidence that one drug was superior to another in the treatment of angina or to prolong total exercise duration. There is a paucity of data comparing the efficacy of anti-anginal agents. The little available evidence shows that no anti-anginal drug is superior to another and equivalence has been shown only for three classes of drugs. Guidelines draw conclusions not from evidence but from clinical beliefs.

Chronic stable angina

2019 ◽  
pp. 91-106
Author(s):  
Gaetano Antonio Lanza ◽  
Antonio De Vita
Keyword(s):  
Stable Angina ◽  
Myocardial Oxygen Consumption ◽  
Beta Blockers ◽  
Chronic Stable Angina ◽  
Pharmacological Therapy ◽  
Lifestyle Changes ◽  
Channel Blockers ◽  
Variable Combination ◽  
Improve Clinical Outcome ◽  
Risk Factor Burden

Treatment of patients with chronic stable angina has two main objectives: to improve clinical outcome and to reduce angina symptoms. Prognosis is mainly improved by a reduction in cardiovascular risk factor burden, which may be achieved by appropriate lifestyle changes and, for some risk factors (e.g. hypercholesterolaemia, hypertension, diabetes), appropriate pharmacological therapy (including, in particular, statins and renin–angiotensin–aldosterone system inhibitors) and use of antithrombotic agents. Symptoms can be improved by a variable combination of traditional (beta-blockers, calcium channel blockers, nitrates) and novel (e.g. ivabradine, ranolazine) anti-ischaemic drugs, which may act through reduction in myocardial oxygen consumption and/or improvement of myocardial perfusion.

Chronic stable angina

2019 ◽  
pp. 91-106
Author(s):  
Gaetano Antonio Lanza ◽  
Antonio De Vita
Keyword(s):  
Stable Angina ◽  
Myocardial Oxygen Consumption ◽  
Beta Blockers ◽  
Chronic Stable Angina ◽  
Pharmacological Therapy ◽  
Lifestyle Changes ◽  
Channel Blockers ◽  
Variable Combination ◽  
Improve Clinical Outcome ◽  
Risk Factor Burden

Treatment of patients with chronic stable angina has two main objectives: to improve clinical outcome and to reduce angina symptoms. Prognosis is mainly improved by a reduction in cardiovascular risk factor burden, which may be achieved by appropriate lifestyle changes and, for some risk factors (e.g. hypercholesterolaemia, hypertension, diabetes), appropriate pharmacological therapy (including, in particular, statins and renin–angiotensin–aldosterone system inhibitors) and use of antithrombotic agents. Symptoms can be improved by a variable combination of traditional (beta-blockers, calcium channel blockers, nitrates) and novel (e.g. ivabradine, ranolazine) anti-ischaemic drugs, which may act through reduction in myocardial oxygen consumption and/or improvement of myocardial perfusion.

scholarly journals Why Nicorandil is not Considered to be the First-line Antianginal Drug

Medicina ◽  
2020 ◽  
pp. 25-47
Author(s):  
S. N. Bel'diev ◽  
◽  
E. V. Andreeva ◽  
E. I. Berezina ◽  
I. V. Egorova ◽  
...  
Keyword(s):  
Beta Blockers ◽  
Channel Blockers ◽  
Concomitant Treatment ◽  
First Line ◽  
Short Term ◽  
Term Trial ◽  
Antianginal Drugs ◽  
Long Acting ◽  
Antianginal Efficacy

According to the results of several short-term randomized controlled trials (RCTs), nicorandil is not inferior in its antianginal efficacy to beta-blockers (BB), calcium channel blockers (CCB) and long-acting nitrates (LAN). At the same time, in some short-term RCTs, as well as in the long-term RCT IONA (2002), it was shown that antianginal efficacy of nicorandil as monotherapy or in combination with other antianginal drugs did not differ from placebo. Ability of nicorandil to reduce the risk of adverse cardiovascular events, demonstrated in the RCT IONA, requires confirmation in a long-term trial with a stronger primary endpoint and concomitant treatment that would meet the current guidelines for the management of patients with chronic coronary syndromes. In this regard, and also taking into account the proven ability of nicorandil to cause gastrointestinal ulcerations, European experts currently consider nicorandil as a drug that is inferior in priority of choice to the first-line antianginal drugs (BB, CCB) and, in some cases, to the second-line drugs (LAN, ivabradine, ranolazine, trimetazidine).

scholarly journals GUIDELINES ON ARTERIAL HYPERTENSION MANAGEMENT OF THE EUROPEAN SOCIETY OF CARDIOLOGY AND EUROPEAN SOCIETY OF HYPERTENSION 2018: WHAT’S NEW?

The Clinician ◽  
2018 ◽  
Vol 12 (2) ◽  
pp. 10-15
Author(s):  
A. A. Klimenko ◽  
D. A. Anichkov ◽  
N. A. Demidova
Keyword(s):  
Arterial Hypertension ◽  
European Society ◽  
Beta Blockers ◽  
Ambulatory Monitoring ◽  
White Coat Hypertension ◽  
General Strategy ◽  
Masked Hypertension ◽  
Angiotensin Ii Receptor ◽  
European Society Of Cardiology ◽  
Selection Of

The article considers the key points of the new 2018 guidelines of the European Society of Cardiology and European Society of Hypertension on management and treatment of patients with arterial hypertension (AH). The guidelines widen the possibilities for ambulatory monitoring of blood pressure (BP) and at-home measurement of BP in diagnosis of AH, especially for detection of hidden (“masked”) hypertension and white-coat hypertension. New target ranges for BP depending on age and concomitant pathology are established. For most patients, BP <140 mm Hg (primary target) is accepted, for patients under 65 years if therapy is well-tolerated BP <130 mm Hg should be achieved. Selection of treatment for elderly patients shouldn’t be based on chronological age but on biological age taking into account evaluation of senile asthenia, self-maintenance and therapy tolerability. For starting selection of drugs for AH, in most patients two-component therapy (one pill drug) is preferable. The latest guidelines contain simplified algorithms for management of patients with AH. It is shown that in most patients, a preference should be made for combinations of renin-angiotensin-aldosterone system blocker (inhibitors of angiotensin-converting enzyme or angiotensin II receptor blockers) with a slow calcium channels blocker and/or thiazide/thiazide-like diuretic. Beta-blockers should be prescribed only for specific clinical cases. Special emphasis is made on evaluation of patient’s treatment adherence as the main reason for insufficient BP control, as well as on increased role of nurses and pharmacists in education, monitoring, and support of patients with AH being an important part of general strategy of BP control.

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