March 31st, 2015

New Consensus for Managing Hypertension in Patients with Coronary Artery Disease

There’s been a lot of drama in the hypertension field over the past few years. Initially sparked by the decision of the National Institutes of Health to halt its sponsorship of national guidelines, the subsequent appearance of multiple guidelines with divergent recommendations led to even more controversy and discussion. Now, however, the appearance of a new scientific statement may indicate that some of the drama is dissipating, at least in one important subset of the field.

The scientific statement from the American Heart Association, the American College of Cardiology, and the American Society of Hypertension covers the important area of the treatment of hypertension in patients with existing coronary artery disease. A key element of the statement is that it is in accord with the Eighth Joint National Committee (JNC 8) guideline and reinforces the blood pressure goal of less than 140/90 mm Hg in this group of patients. “This is important since confusion has arisen in the clinical community over the last year regarding the appropriate target for blood pressure management in the general population,” said Elliott Antman, President of the American Heart Association, in a press statement.

For some patients who have had a previous cardiovascular event, though, a lower target of less than 130/80 mm Hg may be considered appropriate. The statement cautions, however, against lowering blood pressure too rapidly and against lowering diastolic blood pressure lower than 60 mm Hg, particularly in patients over the age of 60.

Beta-blockers are a cornerstone of antihypertensive treatment in this population, though many patients may also require additional drugs. The statement also summarizes important information about the modification of additional cardiovascular risk factors, including weight loss, cholesterol control, smoking cessation, and treatments for diabetes.

Christopher O’Connor, a co-author of the statement, said in an email that the publication represents “a major effort to bring clarity and consensus for hypertension management in cardiac and vascular patients.”




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