2015 AHA/ACC/ASH Scientific Statement on the Treatment of Hypertension in Patients With Coronary Artery Disease

BySteven Lome, MD

Title: Scientific Statement on the Treatment of Hypertension in Patients With Coronary Artery Disease

Year Released: 2015

Societies: American Heart Association, American College of Cardiology, American Society of Hypertension

Summary:

The AHA, ACC and ASH issued recommendations on the treatment of hypertension in the context of CAD prevention and management. Overall, the societies recommend all patients with hypertension and CAD be treated to a blood pressure goal of less than 140/90 mm Hg and that beta-blockers be used as a first-line therapy.

BP goals

In addition to the goal of less than 140/90 mm Hg for people with CAD, patients with acute coronary syndromes (ACS) or heart failure (HF) should also target this goal.

A target of less than 130/80 mm Hg may be appropriate in certain high-risk patients with heart disease and is recommended for individuals with myocardial infarction (MI) or stroke, or to prevent future stroke.

In adults older than 80 years, a BP goal of less than 150/90 mm Hg is recommended.

Hypertension and CAD

In patients with hypertension and chronic stable angina without a prior MI, a beta-blocker should be used. In the presence of prior MI, left ventricular systolic dysfunction, diabetes or chronic kidney disease (CKD), treatment with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) is recommended. The statement also recommends thiazides or thiazide-type diuretics if BP control and volume overload reversal are needed.

Hypertension and ACS

In patients with ACS, hypertension can be treated with standard methods, including beta-blockers, ACE inhibitors or ARBs. Aldosterone antagonists may be used in selected patients. Nitrates should also be considered in this population to lower BP or to relieve ongoing ischemia or pulmonary congestion, but should be avoided in those with suspected right ventricular infarction and those with hemodynamic instability.

Hypertension and HF of ischemic origin

The guidelines recommend targeting risk factors, such as dyslipidemia, obesity, diabetes, smoking, dietary sodium and exercise, among patients with HF. This population should be treated with ACE inhibitors or ARBs, beta-blockers and aldosterone receptor antagonists. Thiazides or thiazide-type diuretics can also be used.

Update Info: Revises the 2007 Scientific Statement Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease from the AHA Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention.

Cardiology Today coverage: https://www.healio.com/cardiology/vascular-medicine/news/online/%7b659eecc4-ba45-45b0-a7ad-3c1cb2abfcb5%7d/new-recommendations-support-lower-bp-target-to-reduce-risk-for-mi-stroke