Treatment of Hypertension in Patients With Coronary Artery Disease

“If you decrease the BP too low, then the flow of blood in the coronary arteries and the oxygen supply to the myocardium will decline. In patients with CAD and the elderly, diastole is the time when the myocardium fills with blood. Caution should be observed in lowering the diastolic BP in patients with CAD or in elderly patients who presumably have more atheroma than younger patients, and the physician should be alert to signs of ischemia as the BP goes down. The diastolic BP should not really be lowered below about 60 mm Hg.”

“In the case of patients who have established coronary artery disease, we have brought beta-blockers from limbo—where they have been consigned—to center stage,”

“This new AHA/ACC/ASH document makes it very clear that for patients with CAD, regardless of age, that the treatment threshold and target is less than 140/90 mm Hg. This panel reaffirmed the [Seventh Joint National Committee (JNC 7)] treatment targets. They further stated that even lower targets are in order for some subgroups of patients with coronary disease, such as those with coexisting kidney disease or peripheral artery disease. I am pleased that they believe it is important to recognize the increased risk of these other conditions. Because HF is highly prevalent among these patients with CAD and hypertension, I would have also encouraged the panel to include it among those with lower treatment targets.”