Blood pressure targets in patients with a coronary artery disease

This article compares two approaches to blood pressure reduction in patients with coronary artery disease (CAD): intensive and standard. The incidence of heart failure, strokes, and cardiovascular-related deaths were compared between patients who received either therapy.

CAD is a condition caused by the narrowing of the coronary arteries which supply blood to the heart muscle. Hypertension (HTN) is defined as a blood pressure higher than 140/90 mmHg at rest. The higher value is called systolic and the lower one is known as diastolic blood pressure. HTN accelerates CAD and puts patients at an elevated risk for strokes and heart attacks. For these reasons, blood pressure reduction is crucial in the management of CAD. However, how low should we get?

Current guidelines recommend blood pressure should be reduced to a systolic blood pressure (SBP) of less than 140 mmHg in patients with HTN. Whether or not a greater reduction in SBP would benefit patients with CAD is currently under debate.

In this meta-analysis (a large analysis of data combined from several similar trials) 15 clinical trials, including more than 65,000 patients with CAD, were reviewed. The data suggests that intensive blood pressure lowering (to a target value of SBP < 135 mmHg) is associated with a 10% reduction in the risk of stroke. A significant reduction of 15 % in the risk of heart failure was also noted. An even greater reduction in blood pressure (to a target of SBP < 130 mmHg) showed a greater reduction in these risks, as well as a reduced risk for heart attacks. However, no benefit was shown in overall survival compared to the standard therapy group (in which target SBP was < 140 mmHg). Intensive therapy also increased the risk of hypotensive (low blood pressure) events. These episodes of low blood pressure also have the potential to be life threatening.

Management of hypertension is crucial in the prevention of life threatening complications in patients with CAD. Intensive therapy (to SBP < 130 mmHg) and a greater reduction in blood pressure correlates to a greater reduction in the risk of strokes and heart failure. However, intensive blood pressure reduction has a risk of hypotension (very low blood pressure), and does not improve the overall survival. 

The original trials that were included in this analysis were not designed to test target blood pressures. Conclusions regarding target pressure were reached after a statistical analysis of the data. In addition, the different drugs used to reduce hypertension were not addressed.

Consult with your doctor regarding your individual target pressure and how to reach it.