Management of Hypertension in Relation to Acute Coronary Syndromes and Revascularisation

Abstract

In patients with acute coronary syndromes (ACS), hypertension is common. The type of ACS and severity of hypertension would determine the treatment algorithm. In ST elevation myocardial infarction (MI), time to reperfusion is essential whereas in malignant hypertension the reduction of blood pressure to prevent end organ damage is the priority. Many therapeutic drugs available for ACS and hypertension are commonly used to treat both these conditions simultaneously. Once the ACS is treated medically, revascularization therapy is likely to be considered. Importantly, optimization of hypertension management may prevent subsequent complications. In this review, we discuss the frequency of hypertension and ACS as single clinical conditions, as well as combined presentations. The pathophysiology of myocardial perfusion in hypertensive patients and the effect of blood pressure (BP) normalization is discussed. This review focuses on treatment strategies from a non-interventional and interventional perspective. Finally, current medications used in treating hypertension in ACS will be compared with regards to their mode of action and prognostic value.

Editorial [Hot Topic: The Clinical Management and Treatment of Hypertension, Its Pathophysiology and the Clinical Use of Antihypertensive Drugs (Executive Editor: Gregory Y.H. Lip)]

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This issue of Current Pharmaceutical Design, for which I have the honour to be Executive Guest Editor, addresses issues relating to the clinical management and treatment of hypertension, its pathophysiology and the clinical use of antihypertensive drugs.Goon et al[1] discuss hypertension, anti-hypertensive therapy and neoplasia, providing an overview establishing the strengths and weaknesses of the arguments presented and highlighting possible pharmacophysiological pathways involved.Aidietis et al [2] then address the role of hypertension in the pathogenesis of cardiac arrhythmias.Kuhl et al [3] then address the important issue of the management of hypertension in relation to acute coronary syndromes and revascularisation. Their review discusses the frequency of hypertension and acute coronary syndromes as single clinical conditions, as well as their combined presentations, which necessitates a pragmatic management approach.

Karthikeyan and Lip [4] then address the area of hypertension in pregnancy, where information on pathophysiology is everexpanding, as well as new insights into management strategies.

Finally, we end on a more controversial note, where Lim and Lip [5] provide a viewpoint on metabolic syndrome and the continuum with diabetes.

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“…Kuhl et al [3] then address the important issue of the management of hypertension in relation to acute coronary syndromes and revascularisation. Their review discusses the frequency of hypertension and acute coronary syndromes as single clinical conditions, as well as their combined presentations, which necessitates a pragmatic management approach.…”