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Review Protocol – BB vs CCB

Review questionWhat is the comparative clinical /cost effectiveness of standard antianginal drugs (beta blockers, calcium channel blockers,) for the management of angina?
InterventionBeta blockers
atenolol, propranolol, bisoprolol, metoprolol, nadolol,

Calcium channel blockers
amlodipine, diltiazem, felodipine, nifedipine, verapamil)
ComparisonBB vs CCBs
OutcomesMortality @ longest available evaluation time point (preferred 5yr, 10 yr)
Preferred outcomes:
All cause mortality Other outcomes:
  • Cardiovascular mortality
Angina frequency/severity
Preferred outcomes:
  • Angina incidence reported in diaries
  • GTN usage
  • CCS score
Exercise tolerance (based on repeat of baseline ETT at a min of 3months follow up)
Preferred outcomes:
  • Total exercise time
Major cardiac events @ longest available evaluation time point (preferred 1yr, 5yr, 10yr)

Preferred outcome:
  • Nonfatal MI
Hospitalisation @ 6m –1yr

Revascularisation @ 1yr, 5yr, 10yr if available

Quality of Life eg EQ-5D, SF-36, HAD, etc @ longest available evaluation time point (preferred 1y, 5y, 10y)
Search strategyThe databases to be searched are Medline, Embase, The Cochrane Library, CINAHL and AMED.

Randomised controlled trials (RCTs) will be considered. If no RCTs are found for certain outcomes such as adverse events, well conducted cohort studies and observational studies may also be considered.

Studies will be restricted to English language only

No date restriction will be applied. Databases will be searched from their date of origin
The review strategyPreferred:
  • Double blind RCTs
  • Minimum n=50 or N=25 if cross over trial
  • Minimum Follow Up = 3m
  • Adverse event data to be sourced from RCTs only
For longer term outcomes (> 1 year)
  • Double blind RCTs
  • Minimum N=200 (consider studies with smaller sample size if large numbers are not available)
  • Adverse event data to be sourced from RCTs only

From: Appendix C, Review Protocols

Cover of Stable Angina
Stable Angina: Methods, Evidence & Guidance [Internet].
NICE Clinical Guidelines, No. 126.
National Clinical Guidelines Centre (UK).
Copyright © 2011, National Clinical Guidelines Centre.

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