The optimal blood pressure target for patients with coronary artery disease.

None of the available outcome-based studies was primarily designed to compare different blood pressure (BP) goals in patients with coronary artery disease (CAD). Consequently, there is uncertainty about the most appropriate BP treatment goal in these patients. Although US guidelines recommend a target less than 130/80 mm Hg, recent European guidelines state that such aggressive target is not consistently supported, therefore making the case for a less aggressive target (<140/90 mm Hg) in all hypertensive patients including those with CAD. A low systolic BP may be beneficial to limit myocardial workload, but an excessive lowering of diastolic BP might impair coronary perfusion, with potentially adverse effects (J-curve phenomenon). The optimal BP target for patients with CAD remains undefined. A reasonable target appears to be in the range of 130-140/80-90 mm Hg. Any further reduction may be safe, but not much productive from a prognostic standpoint.