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NICE

NICE CG126 2016: management of stable angina

This guideline covers the diagnosis confirmation and ongoing management of stable angina in adults, focusing on anti-anginal drug therapy, use of revascularisation, and when to investigate further. It emphasises starting with optimal medical therapy and reserving revascularisation for those with symptoms uncontrolled on drugs or with higher-risk anatomy or prognosis.

NICE2016 editionSummary
Official guidelineStable angina: management (CG126). NICE, 2016.
Read the official guideline · Checked for a newer edition on 2026-10-20
We do not reproduce the guideline text — this page is an independent summary.

Who it applies to

Adults with confirmed stable angina being managed in primary or secondary care, not acute coronary syndrome.

Key recommendations

  • Offer a beta-blocker or a calcium-channel blocker as first-line anti-anginal therapy, choosing based on comorbidities, contraindications and patient preference.
  • If monotherapy does not control symptoms, consider either switching to the other class or using a combination of a beta-blocker and a calcium-channel blocker.
  • If using both a beta-blocker and calcium-channel blocker together, use a dihydropyridine calcium-channel blocker rather than a rate-limiting one such as verapamil or diltiazem to avoid excessive bradycardia or heart block.
  • If symptoms remain uncontrolled on dual first-line therapy and the patient is waiting for or not suitable for revascularisation, consider adding a third anti-anginal drug such as a long-acting nitrate, nicorandil, ivabradine or ranolazine.
  • Only consider a third anti-anginal drug as monotherapy, not first-line dual therapy, when a beta-blocker and calcium-channel blocker are both contraindicated or not tolerated.
  • Offer a short-acting nitrate for immediate relief and prevention of exertional symptoms, with advice on correct use and side effects such as headache and flushing.
  • All patients with stable angina should receive secondary prevention advice and treatment, including aspirin, a statin, and consideration of an ACE inhibitor where indicated, alongside lifestyle advice.
  • Consider coronary angiography with follow-on revascularisation if indicated when symptoms are not satisfactorily controlled with optimal medical therapy.
  • When revascularisation is being considered, take into account the extent and distribution of coronary disease, comorbidities and patient preference when choosing between percutaneous coronary intervention and coronary artery bypass graft.
  • Do not routinely offer revascularisation purely to improve prognosis in patients whose angina is controlled on medical therapy unless specific high-risk anatomical or prognostic features are present.

Practice points for students

  • Beta-blockers and calcium-channel blockers are equally valid first-line choices; the decision is individualised rather than hierarchical.
  • Avoid combining a beta-blocker with a rate-limiting calcium-channel blocker (verapamil or diltiazem) because of the risk of significant bradycardia or heart block.
  • Revascularisation is primarily for symptom control when drugs fail, not a routine prognostic intervention in stable, well-controlled angina.
  • Secondary prevention (statin, aspirin, risk factor control) applies to essentially all patients regardless of whether they have revascularisation.

Condition

Stable angina

Other guidelines on this topic

Independent educational summary written by the WhiteCoat Pro editorial team with AI assistance and checked by a second AI model. It does not reproduce the guideline text, tables or figures, and it is not affiliated with or endorsed by NICE. It is not medical advice: always read the original guideline before applying it to patients.