Angina goals

The goals of treatment are to lower total and LDL cholesterol in order to reduce the risk of first or recurrent events such as myocardial infarction, angina, heart failure, ischemic stroke, or other forms of peripheral arterial disease such as carotid stenosis or abdominal aortic aneurysm. 

Goal BP values are <140/90 for most patients, but <130/80 for patients with diabetes mellitus, significant chronic kidney disease, known coronary artery disease (myocardial infarction [MI], angina), noncoronary atherosclerotic vascular disease (ischemic stroke, transient ischemic attack, peripheral arterial disease [PAD], abdominal aortic aneurysm), or a 10% or greater Framingham 10-year risk of fatal coronary heart disease or nonfatal MI. Patients with LV dysfunction have a BP goal of <120/80 mm Hg. 

When angina occurs more frequently than once a day, chronic prophylactic therapy should be instituted. 8-Blockers may be preferable because of less frequent dosing and other desirable properties (e.g., potential cardioprotective effects, antiarrhythmic effects, lack of tolerance, antihypertensive efficacy). The appropriate dose should be determined by the goals outlined for HR and DP. An agent should be selected that is well tolerated by individual patients at a reasonable cost. Patients most likely to respond well to 8-blockade are those with a high resting HR and those with a relatively fixed anginal threshold (i.e., their symptoms appear at the same level of exercise or workload on a consistent basis). 

Eor acute coronary syndromes (non-ST-segment elevation myocardial infarction and unstable angina), first-line therapy should consist of a /3-blocker and an ACE inhibitor. This regimen will lower BP, control acute ischemia, and reduce cardiovascular risk. Diuretics can be added thereafter if the goal BP is not achieved with first-line therapy. 

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