Practice Guidelines

AHA/ACC/ASH Release Guideline on the Treatment of Hypertension and CAD

 


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Am Fam Physician. 2015 Dec 1;92(11):1023-1030.

Key Points for Practice

• A blood pressure target of less than 140/90 mm Hg is recommended in most patients with CAD and hypertension.

• A target of 130/80 mm Hg is reasonable in selected patients with CAD, including those with previous MI, stroke, or CAD risk equivalents.

• Recommended medications for patients with hypertension and chronic stable angina include beta blockers (in those with a history of MI), ACE inhibitors or ARBs, and thiazide or thiazide-like diuretics.

• Medications with evidence that they reduce risks in patients with ACS include beta blockers, ACE inhibitors or ARBs, and possibly aldosterone antagonists.

From the AFP Editors

The American Heart Association (AHA), American College of Cardiology (ACC), and American Society of Hypertension (ASH) have released a guideline on the management of hypertension in patients with coronary artery disease (CAD). It updates a previous AHA guideline to reflect newer data.

There is a strong association between hypertension and CAD. This guideline uses the best available evidence to make recommendations about blood pressure reduction and the management of CAD and its varying manifestations.

Recommendations

BLOOD PRESSURE GOALS

In patients with CAD and hypertension, a blood pressure target of less than 140/90 mm Hg is reasonable for the secondary prevention of cardiovascular events. A lower target of 130/80 mm Hg may be acceptable in some of these patients with previous myocardial infarction (MI), stroke, or transient ischemic attack, or CAD risk equivalents (carotid artery disease, peripheral artery disease, abdominal aortic aneurysm).

In patients who have CAD with evidence of myocardial ischemia and elevated diastolic blood pressure, blood pressure should be lowered slowly. Clinicians should be cautious when lowering diastolic blood pressure to less than 60 mm Hg in patients with diabetes mellitus or who are older than 60 years. In older patients with hypertension and wide pulse pressures, lowering systolic blood pressure can lead to very low (less than 60 mm Hg) diastolic blood pressure. If this occurs, the clinician should be prompted to assess for troubling signs or symptoms, especially from myocardial ischemia.

MANAGEMENT OF HYPERTENSION IN PATIENTS WITH CAD AND STABLE ANGINA

The management of symptomatic CAD, particularly

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.



 

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