Hypertension and ischemic heart disease

Hypertension is one of the major risk factors for ischemic heart disease and appropriate control of blood pressure is the cornerstone of both primary and secondary ischemic heart disease prevention. Effective blood pressure (BP) control is recommended in primary prevention, i.e., maintaining blood pressure <140/90mmHg, while in secondary prevention values <130/85mmHg used to be recommended. Treatment of hypertension in patients with ischemic heart disease is based on ACE inhibitors and/or AII antagonists (trials HOPE, EUROPA, and PEACE) in combination with beta blockers or with verapamil if beta blockers are not tolerated. According to epidemiologic data, cardiovascular mortality increases with blood pressure, starting as low as from the 110/70mmHg level. Czech, European, and American guidelines from the early 21st century recommend that blood pressure in patients with ischemic heart disease (IHD) be maintained below 130/80 mmHg. Data from the INVEST a ACCORD trials led, however, to reappraisal of these strict recommendations and the blood pressure values currently recommended in secondary prevention correspond to highnormal blood pressure, i.e., 130-139 mmHg/80-89 mmHg. INVEST is the largest clinical trial that focused on hypertonic patients with IHD. Its results showed that verapamil is an appropriate alternative to beta blockers and that while lowering of blood pressure below 140/90mmHg is necessary, its further decrease below 130/80 mmHg is not associated with any additional benefit. Trials with beta blockers demonstrated that lowering of heart rate (HR) improves the patients' prognosis. This hypothesis was definitely verified by trials BEAUTIFUL a SHIFT. The recommended heart rate for patients in secondary prevention is 50-70 bpm. (C) 2012 The Czech Society of Cardiology. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.