XII. Treatment of hypertension in association with ischemic heart disease


A. Recommendations for hypertensive patients with CAD


  1. For most hypertensive patients with CAD, an ACE in-hibitor or ARB is recommended (Grade A).
  2. For hypertensive patients with CAD, but without coex-isting systolic heart failure, the combination of an ACE inhibitor and ARB is not recommended (Grade B).
  3. For high-risk hypertensive patients, when combination therapy is being used, choices should be individualized. The combination of an ACE inhibitor and a dihydropyridine CCB is preferable to an ACE inhibitor and a thiazide/ thiazide-like diuretic in selected patients (Grade A).
  4. For patients with stable angina pectoris but without pre-vious heart failure, myocardial infarction, or coronary ar-tery bypass surgery, either a b-blocker or CCB can be used as initial therapy (Grade B).
  5. Short-acting nifedipine should not be used (Grade D).
  6. When decreasing SBP to target levels in patients withestablished CAD (especially if isolated systolic hyperten-sion is present), be cautious when the DBP is 60 mm Hg because of concerns that myocardial ischemia might be exacerbated, especially in patients with left ventricular hypertrophy (Grade D).

B. Recommendations for patients with hypertension who have had a recent myocardial infarction


  1. Initial therapy should include a b-blocker as well as an ACE inhibitor (Grade A).
  2. An ARB can be used if the patient is intolerant of an ACE inhibitor (Grade A in patients with left ventricular systolic dysfunction).
  3. CCBs may be used in patients after myocardial infarction when b-blockers are contraindicated or not effective. Nondihydropyridine CCBs should not be used when there is heart failure, evidenced by pulmonary congestion on examination or radiography (Grade D).