In a patient with angina and controlled blood pressure, what is the most appropriate therapy for managing symptoms?

In managing symptoms of angina, the primary goal is to reduce myocardial oxygen demand and alleviate chest pain associated with angina episodes. Isosorbide mononitrate is a long-acting nitrate that effectively vasodilates primarily the veins, which decreases preload and subsequently reduces the workload on the heart. This mechanism is particularly beneficial in patients experiencing angina, even when blood pressure is well-controlled.

Isosorbide mononitrate specifically provides symptomatic relief by improving coronary blood flow and increasing exercise tolerance, making it a suitable therapy for patients with angina. Its once-daily dosing along with the prevention of angina episodes can enhance adherence to therapy.

Other options may not be the best choice. While ranolazine can also be used in angina management and is effective for chronic stable angina, it is usually considered as an add-on to beta-blocker therapy rather than the first line in this scenario. Metoprolol tartrate, a beta-blocker, is effective in reducing anginal episodes by lowering heart rate and myocardial oxygen demand but may not provide immediate symptom relief as effectively as nitrates. Hydrochlorothiazide is primarily a diuretic used for hypertension and does not directly address the symptom relief associated with angina.

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