2015 Guidelines on Treatment of Hypertension in Patients With Coronary Artery Disease

Abstract

Patients with coronary artery disease should have intensive treatment of modifiable coronary risk factors. Dietary sodium should be decreased. Hypertension should be treated with beta blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Long-acting nitrates are effective antianginal and antiischemic medications. Calcium channel blockers may be added if angina pectoris persists despite beta blockers and long-acting nitrates. The American Heart Association/American Society of Cardiology 2015 guidelines recommend a target blood pressure below 140/90 mm Hg in patients with coronary artery disease and with an acute coronary syndrome if they are aged 80 years and younger but below 150 mm Hg if they are ≥80 years of age. Octogenarians should be checked for orthostatic changes with standing, and a a systolic blood pressure below 130 mm Hg and a diastolic blood pressure below 65 mm Hg must be avoided. Caution is advised in lowering the diastolic blood pressure below 60 mm Hg in diabetics or in patients older than 60 years of age. In addition to the beta blockers carvedilol, metoprolol CR/XL, and bisoprolol, patients with hypertension and heart failure should be treated with diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and patients with persistent severe symptoms with aldosterone antagonists if not contraindicated.