Interní Med. 2012; 14(2): 59-63

Treatment options for hypertension in patients with ischaemic heart disease

prof.MUDr.Jindřich Špinar, CSc., FESC¹, prof.MUDr.Jiří Vítovec, CSc., FESC²

¹ Interní kardiologická klinika FN Brno a LF MU Brno

² I. interní kardioangiologická klinika FN u sv. Anny a LF MU Brno

Hypertension is one of the major risk factors for ischaemic heart disease with adequate blood pressure control being the cornerstone of

primary as well as secondary prevention of ischaemic heart disease. In terms of primary prevention, it is recommended to control blood

pressure effectively, i.e. to maintain the pressure below 140/90 mm Hg; for patients in secondary prevention, it has been recommended

to keep it below 130/85 mm Hg. The mainstay of hypertension management in patients with ischaemic heart disease is the use of ACE

inhibitors and/or AII antagonists with beta blockers.

Epidemiological data show an increase in cardiovascular mortality starting from a pressure of 110/70 mm Hg. In 2003, the Joint National

Committee published the Seventh Report (JNC 7) which recommended reducing blood pressure in diabetic patients below 130/80 mm Hg

and this has been adopted by most national societies, including the European and Czech 2007 Guidelines that apply the target level also

to patients with ischaemic heart disease, i.e. patients after myocardial infarction and those with stable and unstable angina pectoris. It

is not noted whether the recommended level is also applicable in patients with heart failure of ischaemic aetiology; nevertheless, these

patients are not explicitly excluded.

Data from the INVEST and ACCORD trials, however, have led to a reappraisal of these strict recommendations and the currently recommended

level of blood pressure in secondary prevention is high-normal blood pressure, i.e. 130–139 mm Hg/80–89 mm Hg.

Studies with beta blockers have proved that heart rate reduction results in improved patient prognosis. This hypothesis was definitively confirmed

by the BEAUTIFUL and SHIFT trials of ivabradine. The recommended heart rate for patients in secondary prevention is 50–70 bpm.

Keywords: hypertension, ischaemic heart disease, diabetes mellitus, ACE inhibitors, sartans, beta blockers

Published: February 22, 2012  Show citation