2015 American Heart Association | American College of Cardiology

Hypertension is a major risk  factor for cardiovascular disease [1-9]. Hypertension is present in approximately 69% of patients with a first myocardial infarction. This editorial will discuss the 2015 American Heart Association/American College of Cardiology/American Society of Hypertension guidelines on treatment of hypertension in patients with coronary artery disease.Previous hypertension guidelines have recommended reducing the blood pressure in patients with coronary artery disease and hypertension to less than 140/90 mm Hg, to less than 130/80 mm Hg with consideration of lowering the blood pressure to less than 120/80 mm Hg if left ventricular systolic dysfunction is present to less than 140/90 mm Hg in patients younger than 80 years and the systolic blood pressure to 140-145 mm Hg if tolerated in patients aged 80 years and older, to less than 140/90 mm Hg in patients younger than 80 years and to less than 150/90 mm Hg in patients aged 80 years and older and to less than 140/90 mm Hg .

A study of 4,162 patients with acute coronary syndromes found that the lowest incidence of cardiovascular events occurred with a s blood pressure of 130-140/ 80-90 mm Hg. In a study of 8,354 coronary artery disease patients, the primary outcome of death, nonfatal myocardial infarction, or nonfatal stroke occurred in 9.36% with a systolic blood pressure (SBP) <140 mm Hg, in 12.71% with a 140-149 mm Hg SBP, and in 21.3% with a ≥ 150 mm Hg SB. Compared with a <140 mm Hg SBP, a 140 to 149 mm Hg SBP increased cardiovascular death 34%, all strokes 89%, and nonfatal stroke 70%. Compared with a SBP < 140 mm Hg, a ≥ 150 mm Hg SBP increased the primary outcome 82% , all-cause mortality 60%, cardiovascular death 218%, and all strokes 283%.

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