AHA guidelines for controlling hypertension in CAD patients

STRATEGY

The mainstays of angina treatment are b-blockers, CCBs, and nitrates and for prevention of cardiovascular events in these patients include ACE inhibitors, ARBs, thiazide and thiazide-like diuretics, b-blockers (particularly after MI), CCBs, antiplatelet drugs, and drugs for the treatment of dyslipidemia. .

Patients with hypertension and chronic stable angina should be treated with a regimen that includes:

a) b-blocker in patients with a history of prior MI

b) An ACE inhibitor or ARB if there is prior MI, LV systolic dysfunction, diabetes mellitus, or CKD; and

c) A thiazide or thiazide-like diuretic (Class I; Level of Evidence: A).

The combination of a b-blocker, an ACE inhibitor or ARB, and a thiazide or thiazide-like diuretic should also be considered in the absence of a prior MI, LV systolic dysfunction, diabetes mellitus, or proteinuric CKD (Class IIa; Level of Evidence: B).

If b-blockers are contraindicated or produce intolerable side effects, a nondihydropyridine CCB (such as diltiazem or verapamil) may be substituted, but not if there is LV dysfunction (Class IIa; Level of Evidence: B).

If either the angina or the hypertension remains uncontrolled, a long-acting dihydropyridine CCB can be added to the basic regimen of b-blocker, ACE inhibitor, and thiazide or thiazide-like diuretic.

The combination of a b-blocker and either of the nondihydropyridine CCBs (diltiazem or verapamil) should be used with caution in patients with symptomatic CAD and hypertension because of the increased risk of significant bradyarrhythmias and HF(Class IIa; Level of Evidence: B).

For patients with stable angina, the BP target is < 140/ 90 mm Hg. (Class I; Level of Evidence: A).

However, a lower target BP (<130/80 mm Hg) may be considered in some individuals with CAD, with previous stroke or transient ischemic attack, or with CAD risk equivalents (carotid artery disease, PAD, abdominal aortic aneurysm) (Class IIb; Level of Evidence: B)

There are no special contraindications in hypertensive patients for the use of antiplatelet or anticoagulant drugs, except that in patients with uncontrolled severe hypertension who are taking antiplatelet or anticoagulant drugs, the BP should be lowered without delay to reduce the risk of hemorrhagic stroke (Class IIa; Level of Evidence: C).

Article Source:

http://hyper.ahajournals.org/site/misc/StmtGuidelines.xhtml