The AHA Guidelines and Scientific Statements Handbook

The AHA Guidelines and Scientifi c Statements Handbook

Table

11.7

Treatment of hypertension in the prevention and management of coronary artery disease

General CAD Prevention

High CAD Risk*

Stable Angina

UA/NSTEMI

STEMI

LVD

BP target (mm Hg)

<140/90

<130/80

<120/80

Lifestyle modifi cation

†

Yes

Specifi c drug indications

Any effective anti-hypertensive drug or combination

‡

ACEI or ARBor CCBor Thiazide diureticor Combination

β-B (if patient is hemodynamically stable)andACEI or ARB

§^

ACEI or ARBandβ-BandAldosterone antagonist

¶

andThiazide or loop diureticandHydralazine/Isosorbide dinitrate

(African-Americans)

Comments

If SBP

≥160 mm Hg or DBP

≥100 mm Hg, then start with two drugs.

If

β-B contraindicated, or if side-effects, can substitute diltiazem or verapamil (but not if bradycardia or LVD).

Can add dihydropyridine CCB (not diltiazem or

varapamil) to

β-B.

A thiazide diuretic can be added for BP control.

Contraindicated: Verapamil, diltiazem,

clonidine, moxonidine,

α-blockers

* Diabetes, chronic kidney disease, known CAD or CAD equivalent (carotid artery disease, peripheral arterial disease, abdominal

aortic aneurism), or 10-year Framingham risk score of

≥10% (see Fig. 11.5).

† Weight loss if appropriate, healthy diet (including sodium restriction), exercise, smoking cessation, alcohol moderation (see

Table 11.6).

‡ Evidence supports ACE inhibitor (or ARB), CCB or thiazide diuretic as fi rst line therapy.§ If anterior MI, if hypertension persists, if LV dysfunction or HF, or if the patient has diabetes.¶ If severe HF (NYHA Class III or IV, or EF

<40% and clinical heart failure). See text.

Reprinted, with permission, from Rosendorff

et^

al.

[4].