Management of Hypertension in Patients with Ischemic Heart Disease

Abstract

Ischemic heart disease (IHD) affects about 16 million adults in the USA. Many more individuals likely harbor subclinical coronary disease. Hypertension (HTN) continues to be a potent and widespread risk factor for IHD. Among other Framingham risk factors of tobacco use, diabetes mellitus, dyslipidemia, and left ventricular hypertrophy, HTN plays an independent role in augmenting IHD risk, as well as a multiplicative role with respect to adverse outcomes when HTN is present concurrently with the other major IHD risk factors listed above. Over the past two decades, numerous studies and guideline reports have been presented with the aims of (a) elucidating the pathophysiology of IHD, (b) delineating an ideal blood pressure (BP) threshold at which to institute pharmacotherapy, and (c) defining the optimal pharmacologic elements of a therapeutic regimen. While there are active debates surrounding the existence and relevance of the J curve in IHD patients who have HTN, as well as the numerical level of the BP cutoff justifying drug therapy in the general population, there is a general consensus that the BP target in IHD patients should be lower than 140/90 mmHg. The most appropriate class (or classes) of medication recommended will depend on the comorbid conditions associated with each individual patient. Overall, however, there is no major evidence underscoring a significant difference between drug classes, provided the target BP is achieved, although it should be pointed out that the most recent (2015) American Heart Association (AHA)/American College of Cardiology (ACC)/American Society of Hypertension (ASH) guideline statement now elevates beta-blockers (BB) to the same level of recommendation as other classes of hypertension drugs in the treatment of patients who have hypertension and ischemic heart disease. Although most agents that reduce blood pressure will correspondingly lower myocardial workload, BB may exhibit a special advantage in IHD patients because BB (as well as verapamil and diltiazem subclasses of calcium channel blockers or CCB) act to lower HR as well as cardiac inotropy. Moreover, BB will remain an integral if not indispensable part of the management of IHD, especially in those with history of angina pectoris or MI, based on decades of favorable clinical as well as trial experience. This extensive salutary historical background has served as a foundation for the 2015 committee's decision to bring BB into the front rank of BP agents for those hypertensive individuals suffering simultaneously from IHD.

ICAM‐1 and MKL‐1 polymorphisms impose considerable impacts on coronary heart disease occurrence

“…Studies suggest that patients with hypertension (HTN) had 3‐4 times higher risk of suffering from CHD. In the meanwhile, hypertension is independent of other risk factors to have a continuous and rising relationship with the onset of CHD 19 . Patients with diabetes have high incidence of CVD, and their risk of developing CHD is 2‐4 times as high as that of non‐diabetic patients 20,21 .…”

Impact of a system-wide quality improvement initiative on blood pressure control: a cohort analysis

“…Otherwise, patients who could benefit from treatment may not receive it. This is particularly important as ischaemic heart disease is a leading cause of death20 and uncontrolled BP is a major risk factor for ischaemic heart disease 21…”

Effects of bisoprolol in combination with trimetazidine on the treatment of heart failure and concomitant chronic obstructive pulmonary disease

“…Activation of β2 receptors can maintain normal trachea relaxation and glucolipid metabolism. When these receptors are blocked, glucolipid metabolism will be affected, causing bronchial spasm 10,11. As COPD patients with heart failure usually have poor conditions in the respiratory system, it is crucial to choose appropriate β receptor blockers.…”