You prescribe bisoprolol, a beta blocker, as you remember that these drugs may reduce anginal pain because they reduce cardiac output and thus oxygen demand of the heart. A cardioselective beta blocker like bisoprolol is guideline‑preferred for stable angina unless contraindicated and it tackles the supply-demand mismatch that triggers symptoms during activity. You also decide to prescribe sublingual glyceryl trinitrate (GTN, a nitrate), so that Mr. Garcia can use it prior to strenuous activities or during acute episodes.  

Please click on the blue button to read about the use of beta blockers in variant angina. 

Six months later 

Mr Garcia attends his follow-up appointment. His heart rate is 65bpm and his blood pressure 125/85mmHg. Mr Garcia informs you that he feels well on most days. However, you are concerned that the symptoms have not fully resolved, and you think it’s a good idea to add another drug to his regimen.   

Which drug is most appropriate for Mr. Garcia?