Please note: this guideline has exceeded its review date and is currently under review by specialists. Exercise caution in the use of the clinical guideline.
Refer to the Secondary Prevention of Coronary Heart Disease and Stroke – Antiplatelet guideline
Atenolol oral 25–50mg twice daily
Or if evidence of heart failure:
Bisoprolol oral 1.25–10mg daily or
Carvedilol oral 3.125–25mg twice daily
Caution: Avoid beta-blockers in patients with a history of asthma or bronchospasm.
Alternative options are:
Refer to the Secondary Prevention of Coronary Heart Disease and Stroke - Cholesterol guideline
Ramipril oral 1.25mg–2.5mg twice daily initially depending on blood pressure. Increase after 2 days to 5mg twice daily if tolerated.
Lisinopril - dose according to systolic blood pressure:
Amlodipine oral 5–10mg daily. This is the preferred calcium-channel blocker for patients on a beta-blocker.
Diltiazem oral 60mg three times daily or 200–500mg long-acting formulation once daily (e.g. Tildiem LA®). Always prescribe diltiazem by brand name. Never prescribe a rate limiting calcium-channel blocker together with a beta-blocker unless advised by a consultant.
Isosorbide mononitrate oral 10–40mg twice daily (prescribe 8am and 2pm). Nitrate free period recommended (usually at night) to avoid developing tolerance.