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In a new, joint scientific statement, the American Heart Association (AHA), the American College of Cardiology (ACC) and the American Society of Hypertension offers recommendations for treating hypertension in patients with coronary artery disease (CAD).
The document, which is an update from a previous statement published in 2007, “summarizes the published data relating to the treatment of hypertension in the context of CAD prevention and management,” the writing committee tasked with drafting the statement wrote. “It attempts, on the basis of the best available evidence to develop recommendations that will be appropriate for both BP reduction and the management of CAD in its various manifestations.”
According to the statement, a BP target of less than 140/90 mm Hg is considered reasonable to avoid myocardial infarctions (MIs) and strokes, but a target of less than 130/80 mm Hg may be appropriate in some patients with heart disease who have already experienced a stroke, MI or transient ischemic attack (TIA).
“The writing committee reinforces the target of less than 140/90 to prevent heart attacks and strokes in patients with hypertension and coronary artery disease,” Elliott Antman, MD, president of the American Heart Association and professor of medicine at Harvard Medical School, said in a press release. “This is important since confusion has arisen in the clinical community over the last year regarding the appropriate target for blood pressure management in the general population.”
The statement also addresses the use of BP-lowering drugs. Although most patients will not experience issues with standard medications, the writing committee recommends that clinicians use caution when treating those with coronary artery blockages. In these patients, BP should be lowered slowly, according to the statement, and they should not aim to decrease diastolic BP to less than 60 mm Hg, especially among those aged older than 60 years.
Further, the statement provides recommendations and contraindications on which antihypertensive medications may be optimal for use in patients with different types of heart disease. The majority will take a beta-blocker alone or in combination with other classes of drugs.
“In the spectrum of drugs available for the treatment of hypertension, beta-blockers assume center stage in patients with coronary artery disease,” Clive Rosendorff, MD, PhD, chair of the writing committee and professor of medicine at the Icahn School of Medicine at Mount Sinai Medical Center in New York, said in the release.
Dr. Rosendorff, who is also director of graduate medical education at the Veterans Administration in Bronx, New York, touched on other aspects of the scientific statement as well.
“In addition to treating hypertension, this statement also recognizes the importance of modifying other risk factors for heart attack, stroke and other vascular disease, including abdominal obesity, abnormal cholesterol, diabetes and smoking,” Dr. Rosendorff said.
