A new scientific statement issued jointly by three medical organizations and published in the American Heart Association’s journal Hypertension, addresses how low to aim when treating patients with high blood pressure who also have vascular diseases.
The document provides an up-to-date summary on treating hypertension in patients who have both high blood pressure and have had a stroke, heart attack or some other forms of heart disease, said Elliott Antman, MD, president of the AHA and professor of medicine at Harvard Medical School.
“The writing committee reinforces the target of less than 140/90 to prevent heart attacks and strokes in patients with hypertension and coronary artery disease,” he said. “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.”
The current statement is issued jointly by the American Heart Association, American College of Cardiology, and American Society of Hypertension. According to the statement, while a target of less than 140/90 is reasonable to avoid heart attacks and strokes, a lower target of less than 130/80 may be appropriate in some individuals with heart disease who have already experienced a stroke, heart attack, or transient ischemic attack or who have other cardiovascular conditions such as a narrowing of leg arteries or abdominal aortic aneurysm.
While blood pressure lowering can be done safely using standard medications for most patients, the statement recommends clinicians use caution in patients with coronary artery blockages. In these cases, the committee advises blood pressure should be lowered slowly and strive not to decrease the diastolic blood pressure to less than 60 mm Hg, particularly in patients more than 60 years old.
The statement offers specific, evidence-based recommendations and contraindications to help clinicians select which anti-hypertensive medications to use in patients with various types of heart disease. For most patients, that will mean taking a beta-blocker by itself or in combination with other classes of drugs. For more information, go to heart.org.