Which intervention is most appropriate for a patient with angina and elevated blood pressure not meeting goals?

In patients experiencing angina with elevated blood pressure that does not meet treatment goals, the most appropriate intervention is to incorporate amlodipine, as it addresses both issues simultaneously. Amlodipine is a calcium channel blocker that effectively lowers blood pressure by causing vasodilation. This action can help alleviate the workload on the heart, thereby reducing angina symptoms.

Additionally, managing blood pressure is critical in patients with ischemic heart disease, as hypertension can exacerbate cardiac workload and increase the risk of adverse cardiovascular events. Amlodipine is particularly beneficial in this context because it has a well-documented role in the management of angina and can be optimized to improve blood pressure control.

While ranolazine is an option for angina, it doesn't have a significant effect on blood pressure, making it less suitable in this scenario where blood pressure control is also a major concern. Increasing the dose of metoprolol may help with angina but may not effectively address the elevated blood pressure if the current dose is insufficient. Isosorbide mononitrate, being a nitrate, is more focused on angina relief and does not provide a direct antihypertensive effect, which is a critical aspect of this patient's management. Hence, the