Recommendations for treatment of hypertension in coronary artery disease

This paper reviewed the American Heart Association guildelines for the treatment of hypertension in patients with coronary artery disease.

Coronary artery disease (CAD) refers to a build-up of substances in the blood vessels to the heart. This obstructs blood flow and can increase the risk of angina (chest pain) and heart attack. Hypertension refers to high blood pressure. It increases the risk of developing CAD, stroke and kidney failure. Effective antihypertensive therapy can reduce the risk of CAD.

The American Heart Association has issued guidelines on the treatment of hypertension in patients who have already developed CAD.

Studies have demonstrated that lowering of blood pressure is more important than the particular drug type used in preventing complications in CAD. Various drugs types are used to reduce blood pressure. A combination of drug types are usually needed.

Thiazide diuretics are highly effective in reducing blood pressure. Beta blockers are the standard of care in patients with chest pain, previous heart attack, and those who have left ventricular dysfunction (left side of heart can’t pump effectively). The beta blockers carvedilol (Coreg), metoprolol (Lopressor), and bisoprolol (Zebeta) were shown to improve outcomes in patients with heart failure.

ACE inhibitors prevent heart failure. When combined with thiazide diuretics, ACE inhibitors reduce the likelihood of comlications such as stroke happening again. Treatment with perindopril (Aceon) was associated with a 20% decreased risk of death or heart attack. Angiotensin II receptor blockers (ARBs) are often considered to be an alternative therapy in patients who cannot take ACE inhibitors.

It is reasonable to target to reduce blood pressure to less than 140/90 mmHg. Recommendations for patients with hypertension and chronic chest pain on exertion were given. These patients should receive a beta blocker if they had a previous heart attack, an ACE inhibitor or ARB if there is prior heart attack, left ventricular systolic dysfunction, diabetes, or chronic kidney disease and a thiazide diuretic.

In patients with stabilized heart attack or chest pain, one trial showed that hypertension increased the risk of death and heart attack at 90 days. These patients should receive beta blocker therapy such as metoprolol or bisoprolol within 24 hours of presenting symptoms.

Patients with heart failure and hypertension should be treated with ACE inhibitors, β-blockers and aldosterone receptor antagonists. 

The authors of this study presented the current guidelines for the treatment of patients with hypertension and coronary artery disease.