Hypertension Management Recommendations

1. β-Blockers should be administered as soon as possible after CABG, in the absence of contraindications, to reduce the risk of postoperative AF and to facilitate BP control early after surgery (Class I; Level of Evidence A).
2. ACE inhibitor therapy should be administered after CABG for patients with recent MI, LV dysfunction, diabetes mellitus, and chronic kidney disease, with careful consideration of renal function in determining the timing of initiation and dose selection after surgery (Class I; Level of Evidence B).
3. With the use of antihypertensive medications, it is reasonable to target a BP goal of <140/85 mm Hg after CABG; however the ideal BP target has not been formally evaluated in the CABG population (Class IIa; Level of Evidence B).
4. It is reasonable to add a calcium channel blocker or a diuretic agent as an additional therapeutic choice if the BP goal has not yet been achieved in the perioperative period after CABG despite β-blocker therapy and ACE inhibitor therapy as appropriate (Class IIa; Level of Evidence B).
5. In the absence of prior MI or LV dysfunction, antihypertensive therapies other than β-blockers should be considered for chronic hypertension management long term after CABG (Class IIb; Level of Evidence B).
6. Routine ACE inhibitor therapy is not recommended early after CABG among patients who do not have a history of recent MI, LV dysfunction, diabetes mellitus, or chronic kidney disease because it may lead to more harm than benefit and an unpredictable BP response (Class III; Level of Evidence B).