Management of hypertension in patients with coronary artery disease.

Hypertension is present in three of four patients with coronary artery disease (CAD) but remains largely uncontrolled in most patients. Treating hypertension in these patients is complicated by the concern of precipitating coronary ischemia when diastolic blood pressure (DBP) is reduced excessively. However, an emerging body of evidence from recent clinical trials in high-risk hypertensive patients with or without CAD demonstrated the benefit of intensive drug therapy, even when DBP fell much lower than 80 mm Hg, in terms of reducing cardiovascular events and progression of coronary and carotid atherosclerosis. Accordingly, the American Heart Association has now set the target BP goal to less than 130/80 mm Hg in hypertensive patients with CAD. Given the enormous gap between current BP levels in patients with CAD and the new target BP goals, multiple drug therapy is essential to achieve BP control and improve cardiovascular outcomes.