Optimal medical treatment of hypertension in patients with coronary artery disease

Dhruv Mahtta; Islam Y. Elgendy; Carl J. Pepine

doi:10.1080/14779072.2018.1534069

Optimal medical treatment of hypertension in patients with coronary artery disease

Dhruv Mahtta
, Islam Y. Elgendy
, Carl J. Pepine

Research output: Contribution to journal › Review article › peer-review

10 Scopus citations

Abstract

Introduction: Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, and hypertension is its most prevalent modifiable risk factor. Patients with CAD and concomitant hypertension are a special population with distinct physiologic and structural alterations. Optimal blood pressure (BP) control in this population has been linked with reduction in adverse outcomes, however, excessive lowering of BP could jeopardize myocardial and cerebral perfusion. Areas covered: Authors highlight the prevalence of the CAD and hypertension dyad, as well as the implications of various structural and physiological changes in this population. Subsequently, available data on optimal BP targets in such patients, and lastly the J-curve phenomenon as well as antihypertensive agent use are discussed. Expert commentary: Current guideline recommendations are based on data from trials such as SPRINT and ACCORD which did not specifically focus on the CAD population. Based on data from observational studies and post hoc analyses, the best therapeutic systolic (SBP) and diastolic (DBP) targets may be ~ 130 mmHg and ~ 80 mmHg, respectively. Caution should be taken to not lower SBP below 120 mmHg and DBP below 60 mmHg.

Original language	English
Pages (from-to)	815-823
Number of pages	9
Journal	Expert Review of Cardiovascular Therapy
Volume	16
Issue number	11
DOIs	https://doi.org/10.1080/14779072.2018.1534069
State	Published - Nov 2 2018

Bibliographical note

Publisher Copyright:
© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.

Funding

CJ Pepine receives support from the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine; NIH NCATS—University of Florida Clinical and Translational Science UL1TR001427; and PCORnet-OneFlorida Clinical Research Consortium CDRN-1501-26692. CJ Pepine also reports grant support (significant) from Adelphi Values (Qualitative MVA), Amorcyte (PRESERVE), Athersys (MI-NSTEMI), BioCardia (CardiAMP), Brigham and Women’s Hospital (INVESTED), Capricor (ALLSTAR), Cytori Therapeutics (ATHENA), Duke Univ. (ADAPTABLE), Gilead Sciences Inc. (RWISE, Univ. FL site), Merck & Co. Inc. (VICTORIA), Mesoblast (TEVA, Univ. FL site), NIH/NHLBI (CONCERT), US Dept. of Defense (WARRIOR), Ventrix (CV-201); educational support (modest) for the Vascular Biology Working Group from Amgen Inc., AstraZeneca Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc., Daiichi Sankyo, Ionis, Relypsa; Consultant fees/honoraria (modest) from Amgen Inc., AstraZeneca Pharmaceuticals, Bayer Healthcare Pharmaceuticals, Gilead, Merck and (significant) from Ironwood Pharmaceuticals Inc. and SLACK Inc.; is a Task force member (no compensation) for Foundation for the Accreditation of Cellular Therapy. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Funders	Funder number
Avedisian School of Medicine Department of Medicine
Gatorade Trust
NIH NCATS
PCORnet-OneFlorida Clinical Research Consortium	CDRN-1501-26692
Clinical and Translational Science Institute, University of Florida
National Institutes of Health (NIH)
Patient-Centered Outcomes Research Institute
National Center for Advancing Translational Sciences (NCATS)	UL1TR001427
Florida AandM University and Florida State University

Keywords

Antihypertensives
coronary auto-regulation
endothelial dysfunction
J-curve phenomenon
major adverse cardiovascular events
pulse-wave velocity
target blood pressure

ASJC Scopus subject areas

Internal Medicine
Cardiology and Cardiovascular Medicine

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10.1080/14779072.2018.1534069

Cite this

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title = "Optimal medical treatment of hypertension in patients with coronary artery disease",

abstract = "Introduction: Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, and hypertension is its most prevalent modifiable risk factor. Patients with CAD and concomitant hypertension are a special population with distinct physiologic and structural alterations. Optimal blood pressure (BP) control in this population has been linked with reduction in adverse outcomes, however, excessive lowering of BP could jeopardize myocardial and cerebral perfusion. Areas covered: Authors highlight the prevalence of the CAD and hypertension dyad, as well as the implications of various structural and physiological changes in this population. Subsequently, available data on optimal BP targets in such patients, and lastly the J-curve phenomenon as well as antihypertensive agent use are discussed. Expert commentary: Current guideline recommendations are based on data from trials such as SPRINT and ACCORD which did not specifically focus on the CAD population. Based on data from observational studies and post hoc analyses, the best therapeutic systolic (SBP) and diastolic (DBP) targets may be \textasciitilde{} 130 mmHg and \textasciitilde{} 80 mmHg, respectively. Caution should be taken to not lower SBP below 120 mmHg and DBP below 60 mmHg.",

keywords = "Antihypertensives, coronary auto-regulation, endothelial dysfunction, J-curve phenomenon, major adverse cardiovascular events, pulse-wave velocity, target blood pressure",

author = "Dhruv Mahtta and Elgendy, \{Islam Y.\} and Pepine, \{Carl J.\}",

note = "Publisher Copyright: {\textcopyright} 2018, {\textcopyright} 2018 Informa UK Limited, trading as Taylor \& Francis Group.",

year = "2018",

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doi = "10.1080/14779072.2018.1534069",

language = "English",

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AU - Elgendy, Islam Y.

AU - Pepine, Carl J.

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N2 - Introduction: Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, and hypertension is its most prevalent modifiable risk factor. Patients with CAD and concomitant hypertension are a special population with distinct physiologic and structural alterations. Optimal blood pressure (BP) control in this population has been linked with reduction in adverse outcomes, however, excessive lowering of BP could jeopardize myocardial and cerebral perfusion. Areas covered: Authors highlight the prevalence of the CAD and hypertension dyad, as well as the implications of various structural and physiological changes in this population. Subsequently, available data on optimal BP targets in such patients, and lastly the J-curve phenomenon as well as antihypertensive agent use are discussed. Expert commentary: Current guideline recommendations are based on data from trials such as SPRINT and ACCORD which did not specifically focus on the CAD population. Based on data from observational studies and post hoc analyses, the best therapeutic systolic (SBP) and diastolic (DBP) targets may be ~ 130 mmHg and ~ 80 mmHg, respectively. Caution should be taken to not lower SBP below 120 mmHg and DBP below 60 mmHg.

AB - Introduction: Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, and hypertension is its most prevalent modifiable risk factor. Patients with CAD and concomitant hypertension are a special population with distinct physiologic and structural alterations. Optimal blood pressure (BP) control in this population has been linked with reduction in adverse outcomes, however, excessive lowering of BP could jeopardize myocardial and cerebral perfusion. Areas covered: Authors highlight the prevalence of the CAD and hypertension dyad, as well as the implications of various structural and physiological changes in this population. Subsequently, available data on optimal BP targets in such patients, and lastly the J-curve phenomenon as well as antihypertensive agent use are discussed. Expert commentary: Current guideline recommendations are based on data from trials such as SPRINT and ACCORD which did not specifically focus on the CAD population. Based on data from observational studies and post hoc analyses, the best therapeutic systolic (SBP) and diastolic (DBP) targets may be ~ 130 mmHg and ~ 80 mmHg, respectively. Caution should be taken to not lower SBP below 120 mmHg and DBP below 60 mmHg.

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KW - coronary auto-regulation

KW - endothelial dysfunction

KW - J-curve phenomenon

KW - major adverse cardiovascular events

KW - pulse-wave velocity

KW - target blood pressure

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Optimal medical treatment of hypertension in patients with coronary artery disease

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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