Hypertensive goals in patients with coronary artery disease.

There are many prospective clinical trials that have examined cardiovascular outcomes over the past 2 decades. Trials completed within the last 5 years clearly indicate that overall cardiovascular risk is reduced by blood pressure lowering to levels below 140/90 mm Hg. Greater cardiovascular risk reduction is not seen, however, by driving blood pressure to levels well below 130/80 mm Hg. This is true across the spectrum of cardio-renal risk with few exceptions, stroke prevention possibly being one. Further there should be an awareness that outcome studies performed within the last decade will not have the same risk reduction of a given class of antihypertensive drug previously tested. This is primarily due to an improved standard of care that was not present in trials of a decade ago and thus, more recent trials have lower cardiovascular risk at baseline. Lastly, new guidelines will most likely change the goal blood pressure to <140/90 mm Hg as all data support this level. Lastly, the caution of lowering diastolic blood pressure below 60 mm Hg especially in the elderly must be avoided to minimize reductions in coronary perfusion.