Treatment of Hypertension in Patients with Coronary Artery Disease. A Case-Based Summary of the 2015 AHA/ACC/ASH Scientific Statement

详细信息    查看全文

• 作者：Clive Rosendorff ; MD ; PhD ; ^{clive.rosendorff@va.gov" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the Writing Committee¹ ; Clive Rosendorff ; MD ; PhD ; DScMed (Chair) ; Daniel T. Lackland ; DrPH (Co-Chair) ; Matthew Allison ; MD ; Wilbert S. Aronow ; MD ; Henry R. Black ; MD ; Roger S. Blumenthal ; MD ; Christopher P. Cannon ; MD ; James A. de Lemos ; MD ; William J. Elliott ; MD ; PhD ; Laura Findeiss ; MD ; Bernard J. Gersh ; MB ChB ; DPhil ; Joel M. Gore ; MD ; Daniel Levy ; MD ; Janet B. Long ; MSN ; Christopher M. O'Connor ; MD ; Patrick T. O'Gara ; MD ; Olugbenga Ogedegbe ; MD ; MPH ; Suzanne Oparil ; MD ; William B. White ; MD
• 关键词：Acute Coronary Syndrome ; Coronary Artery Disease ; Heart Failure ; Hypertension ; Myocardial Infarction ; Stable Angina ; Unstable Angina
• 刊名：The American Journal of Medicine
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：129
• 期：4
• 页码：372-378
• 全文大小：254 K

文摘

The 2015 American Heart Association/American College of Cardiology/American Society of Hypertension Scientific Statement “Treatment of Hypertension in Patients with Coronary Artery Disease” is summarized in the context of a clinical case. The Statement deals with target blood pressures, and the optimal agents for the treatment of hypertension in patients with stable angina, in acute coronary syndromes, and in patients with ischemic heart failure. In all cases, the recommended blood pressure target is <140/90 mm Hg, but <130/80 mm Hg may be appropriate, especially in those with a history of a previous myocardial infarction or stroke, or at high risk for developing either. These numbers may need to be revised after the publication of the SPRINT data. Appropriate management should include beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and in the case of heart failure, aldosterone antagonists. Thiazide or thiazide-like (chlorthalidone) diuretics and calcium channel blockers can be used for the management of hypertension, but the evidence for improved outcomes compared with other agents in hypertension with coronary artery disease is meager. Loop diuretics should be reserved for patients with New York Heart Association Class III and IV heart failure or with a glomerular filtration rate of <30 mL/min.