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The optimal blood pressure target for patients with coronary artery disease

Paolo Verdecchia1, Fabio Angeli, Claudio Cavallini

  • 1Struttura Complessa di Cardiologia, Unità di Ricerca Clinica Cardiologia Preventiva, Ospedale S. Maria della Misericordia, Perugia, Italy. verdec@tin.it

Current Cardiology Reports
|April 29, 2010
PubMed

Insights

The optimal blood pressure (BP) target for patients with coronary artery disease (CAD) is uncertain. A reasonable BP goal appears to be 130-140/80-90 mm Hg, with further reductions offering limited prognostic benefit.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Clinical Guidelines

Background:

  • Current outcome-based studies do not primarily compare different blood pressure (BP) goals in patients with coronary artery disease (CAD).
  • There is significant uncertainty regarding the most appropriate BP treatment target for patients with CAD.
  • Conflicting recommendations exist: US guidelines suggest <130/80 mm Hg, while European guidelines favor <140/90 mm Hg for hypertensive patients, including those with CAD.

Purpose of the Study:

  • To address the uncertainty surrounding the optimal blood pressure (BP) target in patients with coronary artery disease (CAD).
  • To evaluate the potential benefits and risks associated with different BP treatment goals in this patient population.

Main Methods:

  • Review and analysis of existing outcome-based studies related to BP goals in CAD patients.
  • Evaluation of current US and European hypertension guidelines for CAD management.
  • Assessment of the physiological effects of systolic and diastolic BP lowering on myocardial workload and coronary perfusion.

Main Results:

  • No definitive outcome-based studies directly compare various BP goals in CAD patients.
  • A low systolic BP may reduce myocardial workload.
  • Excessive lowering of diastolic BP could impair coronary perfusion, potentially leading to adverse effects (J-curve phenomenon).

Conclusions:

  • The optimal BP target for patients with coronary artery disease (CAD) remains undefined.
  • A reasonable BP target range for CAD patients is suggested to be 130-140/80-90 mm Hg.
  • Further BP reduction beyond this range may be safe but is unlikely to offer significant prognostic advantages.

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