https://immattersacp.org/weekly/archives/2015/04/07/5.htm

Updated guidance issued on treatment of hypertension in patients with CAD

The American Heart Association, American College of Cardiology, and American Society of Hypertension released updated guidance last week on treatment of hypertension in patients with coronary artery disease (CAD).


The American Heart Association, American College of Cardiology, and American Society of Hypertension released updated guidance last week on treatment of hypertension in patients with coronary artery disease (CAD).

The scientific statement updates the American Heart Association's 2007 statement on treatment of hypertension in the prevention and management of ischemic heart disease and focuses on epidemiology and secondary prevention of hypertension in the setting of CAD. The writing group based its recommendations on the best available evidence or, when evidence was lacking, on consensus. Each clinical section of the statement refers to a different subset of patients in an attempt to increase its overall utility.

Regarding blood pressure goals, the statement recommended the following:

  • A target of <140/90 mm Hg is reasonable for secondary prevention of cardiovascular events in patients with hypertension and CAD.
  • A lower target of <130/80 mm Hg may be appropriate in some patients with CAD, previous myocardial infarction, stroke or transient ischemic attack, or CAD risk equivalents (e.g., carotid artery disease, peripheral arterial disease, abdominal aortic aneurysm).
  • Patients with elevated diastolic blood pressure and CAD with evidence of myocardial ischemia should have their blood pressure lowered slowly. Caution is advised in inducing decreases in diastolic blood pressure below 60 mm Hg in patients with diabetes or those who are older than age 60. “In older hypertensive individuals with wide pulse pressures, lowering [systolic blood pressure] may cause very low [diastolic blood pressure] values (<60 mm Hg). This should alert the clinician to assess carefully any untoward signs or symptoms, especially those resulting from myocardial infarction,” the statement said.

Recommendations on management of hypertension in patients with CAD and stable angina, management of hypertension in patients with acute coronary syndrome, general principles of blood pressure management in patients with acute coronary syndrome, and management of hypertension in patients with heart failure of ischemic origin were also provided. The full statement was published online March 31 by Hypertension, Circulation, and the Journal of the American College of Cardiology and is available free of charge.