Health care providers should focus on lowering blood pressure below 140/90 mm Hg to reduce the risk of heart attack and stroke in patients with coronary heart disease, stroke, or other forms of heart disease, according to a scientific statement published March 31 online in Hypertension. 

The statement, issued jointly by the American Heart Association (AHA), American College of Cardiology, and the American Society of Hypertension, also recommends that it may be appropriate to induce a blood pressure of less than 130/80 mm Hg in persons with heart disease who have already had a heart attack, stroke, transient ischemic attack, or in persons who have other cardiovascular conditions such as carotid artery disease, peripheral artery disease, or abdominal aortic aneurysm. 

The statement provides evidence-based recommendations for antihypertensive drugs for patients with different heart conditions. “In the spectrum of drugs available for the treatment of hypertension, beta-blockers assume center stage in patients with coronary artery disease,” said Clive Rosendorff, MD, PhD, chair of the writing committee. 

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Although most patients will do well with standard medications such as a beta-blocker alone or in combination with other classes of drugs, the authors wrote, clinicians should use caution in patients with coronary artery blockages. The group advised lowering blood pressure slowly in these patients and not aiming for a target diastolic blood pressure that is less than 60 mm Hg in patients with diabetes mellitus or who are aged older than 60 years.

In older hypertensive individuals with wide pulse pressures, they added, lowering the systolic blood pressure may result in very low diastolic blood pressure (that is, less than 60 mm Hg), and this should alert the clinician to look for any concerning signs or symptoms, especially those resulting from myocardial ischemia. The authors also recommended checking octogenarians for orthostatic changes with standing and avoiding a blood pressure lower than 130/65 mm Hg in these individuals.

“In addition to treating hypertension, this statement also recognizes the importance of modifying other risk factors for heart attack, stroke, and other vascular disease, including abdominal obesity, abnormal cholesterol, diabetes, and smoking,” said Rosendorff.