A patient‐specific approach to assessing blood pressure management in patients with hypertension and coronary artery disease

Abstract

The objective was to improve the management of patients with hypertension (HTN) and coronary artery disease (CAD), utilizing a model which integrates 3 determinants of coronary blood flow (CBF)-CAD severity, diastolic blood pressure (DBP), and left ventricular (LV) mass. We validated non-parametric equations for CBF estimation in a consecutive patient sample (N = 81) with HTN and CAD. There was a highly significant correlation (r = .565; P < .01) between clinical DBP and estimated CBF. Greater LV mass and more severe CAD shifted the relationship towards less CBF at the same DBP. LV mass was more critical when DBP >70 mm Hg. Estimated changes in CBF at different DBP considering the severity of CAD and LV mass can be calculated. In summary, the severity of CAD from coronary CT or coronary angiography combined with LV mass from echocardiography permits clinicians to guide the extent of, or target for, DBP to avoid seriously compromising CBF. | INTRODUCTIONTarget diastolic blood pressure (DBP) for patients with hypertension (HTN) and coronary artery disease (CAD) has been the subject of some controversy because of the need to lower blood pressure (BP) to pre- The purpose of this study was to produce a better treatment strategy for patients with hypertension and CAD. Specifically, we sought to use the degree of coronary stenosis from either coronary angiography or coronary computed tomography angiography (CCTA) and to integrate it with LV mass in order to develop a patient-specific approach for blood pressure management in patients with hypertension and coronary artery disease. | METHODS | Patient populationThe study population consisted of patients who attended a cardiology clinic at a university hospital. A retrospective case review was con-