The management of hypertension in ischaemic heart disease.
OBJECTIVE
Patients with hypertension and coronary artery disease are often inadequately treated. Blood pressure levels remain unacceptably high in about half of such patients. A significant shortfall exists between guidelines and practice in implementing evidence-based drug therapy.


RESULTS
Recent trials underscore the importance of blood pressure reduction. The purported superiority of specific drug classes, notably angiotensin-converting enzyme inhibitors and beta-blockers, is increasingly debated. Conversely, the benefits of calcium channel blockers are increasingly recognized. Irrespective of differences, all three agents are frequently required to achieve blood pressure targets. Beyond blood pressure reduction, statin therapy is undoubtedly the single most important risk factor intervention. New studies suggest that intensive lipid lowering and greater reductions in low-density lipoprotein cholesterol will further reduce major cardiovascular events. Finally, the impact of smoking cessation, exercise, and diet is often underestimated.


CONCLUSIONS
The prognosis for patients is critically dependent on reducing global cardiovascular risk by addressing all modifiable risk factors. The cornerstone of treatment remains blood pressure reduction, using agents with both antihypertensive and antianginal properties.
Hawkins
Nathaniel M
NM
Cardiology Department, Stobhill Hospital, Glasgow, UK.
Dunn
Francis G
FG
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors