• For symptom relief:
• Sublingual glyceryl trinitrate should be used for the rapid relief of the symptoms of angina and before performing activities known to cause symptoms of angina.
• Prescribe a beta-blocker as first-line regular treatment to reduce the symptoms of stable angina.
• If a beta-blocker is contraindicated or not tolerated, prescribe a calcium-channel blocker (CCB), a nitrate (such as isosorbide mononitrate), or nicorandil.
• Ivabradine is an alternative to a CCB, a nitrate, or nicorandil if a beta-blocker is contraindicated or not tolerated. However, there is less experience with its use in primary care, and it is significantly more expensive than alternative anti-anginal drugs. Primary care prescribers may wish to consider seeking advice from a specialist before initiating ivabradine in primary care, particularly if they are not familiar with its use.
• To improve prognosis:
• All people with stable angina should be taking low-dose aspirin and a statin unless these are contraindicated or not tolerated.
• All people with stable angina should be considered for treatment with an angiotensin-converting enzyme (ACE) inhibitor.
• For people with stable angina and coexisting hypertension, diabetes, heart failure, asymptomatic left ventricular dysfunction, or previous myocardial infarction, an ACE inhibitor should be prescribed unless this is contraindicated or not tolerated.
• For people with stable angina and no coexisting indications for treatment with an ACE inhibitor, any anticipated benefit of treatment should be considered, alongside the costs and potential risks, on an individual basis.

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