New Statement on the Treatment of HTN in Patients With CAD
Patients with hypertension and vascular diseases should aim for a blood pressure target of less than 140/90 mm Hg to prevent myocardial infarction (MI) and stroke, according to a new scientific statement released March 31 by the ACC, American Heart Association, and American Society of Hypertension, and simultaneously published in the Journal of the American College of Cardiology.
The statement, which is an update to the 2007 “Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease,” addresses the prevention of cardiovascular events and sets blood pressure goals for patients with hypertension and coronary artery disease (CAD). It notes that for those patients who have already experienced a stroke, MI or transient ischemic attack, or those who have other cardiovascular conditions, a blood pressure target of less than 130/80 mm Hg may be more appropriate.
The statement further explains that blood pressure lowering can and should be done safely. Most patients will not encounter problems with standard medications, such as a beta-blocker by itself or in combination with another drug. However, clinicians should exercise caution in treating patients with coronary artery blockages and hypertension, lowering blood pressure slowly over time. The statement advises that these patients not lower their diastolic blood pressure to less than 60 mm Hg, especially if the patient is more than 60 years old. Based on evidence from clinical trials and research, the statement makes specific anti-hypertensive medication recommendations for patients with various types of cardiovascular disease.
“In the spectrum of drugs available for the treatment of hypertension, beta-blockers assume center stage in patients with CAD,” said Clive Rosendorff, MD, PhD, FACC, chair of the writing committee, professor of medicine at the Icahn School of Medicine at Mount Sinai Medical Center in New York, and director of graduate medicine education at the Veterans Administration in the Bronx. “In addition to treating hypertension, this statement also recognizes the importance of modifying other risk factors for MI, stroke and other vascular disease, including abdominal obesity, abnormal cholesterol, diabetes and smoking.”
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