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Angina - stable - Management
Which beta-blocker is recommended?

  • CKS recommends atenolol, bisoprolol, or metoprolol as first-choice beta-blockers for the management of angina.
  • The following beta-blockers are licensed for the treatment of angina: propranolol, acebutolol, atenolol, bisoprolol, carvedilol, metoprolol, nadolol, oxprenolol, pindolol, and timolol.
  • For people who have had a previous myocardial infarction, metoprolol (standard release), propranolol (standard release), timolol, or atenolol may be preferred.
  • For people with angina and heart failure, bisoprolol, carvedilol, or nebivolol may be preferred.
Basis for recommendation
  • There is no good evidence that any one beta-blocker is better than any other in the management of stable angina. The efficacy of beta-blockers is thought to be due to a class effect rather than the effects of individual drugs, and such factors as comorbidity, compliance, and cost should be considered when selecting a beta-blocker. Occasionally, an individual may respond better to one beta-blocker than another.
  • Atenolol, bisoprolol, and metoprolol are licensed for the treatment of angina, and they are widely recommended for the management of stable angina [Fox et al, 2006a; SIGN, 2007].
  • Atenolol, bisoprolol, and metoprolol are cardioselective and do not exhibit intrinsic sympathomimetic activity [BNF 57, 2009].
    • Cardioselective beta-blockers may be preferred because of advantages in terms of adverse effects and precautions compared with non-selective beta-blockers.
    • Beta-blockers with intrinsic sympathomimetic activity may be less cardioprotective than those without intrinsic sympathomimetic activity.

[Fox et al, 2006a]

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