Treatment of Hypertension in Association with Ischemic Heart Disease

Recommendations for Hypertensive Patients with Coronary Artery Disease (CAD)

1. For most hypertensive patients with CAD, an ACE inhibitor or ARB is recommended (Grade A).
2. For hypertensive patients with CAD, but without coexisting systolic heart failure, the combination of an ACE inhibitor and ARB is not recommended (Grade B).
3. For high-risk patients, when combination therapy is being used, choices should be individualized. The combination of an ACE inhibitor and a dihydropyridine CCB is preferable to an ACE inhibitor and a thiazide/ thiazide-like diuretic in selected patients (Grade A).
4. For patients with stable angina pectoris but without prior heart failure, myocardial infarction, or coronary bypass surgery, either a beta-blocker or calcium channel blocker can be used as initial therapy (Grade B).
5. Short-acting nifedipine should not be used (Grade D).
6. When decreasing SBP to target levels in patients with established CAD (especially if isolated systolic hypertension is present), be cautious when the diastolic blood pressure is ≤60 mmHg because of concerns that myocardial ischemia may be exacerbated, especially in patients with left ventricular hypertrophy (LVH) (Grade D).