The treatment of patients with hypertension and ischemic heart disease

The prevalence of coronary artery disease has not significantly declined in the past 30 years, and approximately only one in four patients with hypertension is treated to recommended blood pressure levels. Hypertension is a common antecedent of acute myocardial infarction and the association of the two conditions imparts a high risk. Many studies have indicated the benefit of β blockade, angiotensin-converting enzyme inhibition, antiplatelet therapy, and cholesterol-lowering therapy in patients with coronary artery disease with or without heart failure. All four classes of agents are needed in a large proportion of patients with this condition. In the treatment of uncomplicated hypertension, recent data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and second Australian National Blood Pressure Study (ANBP2) suggest that diuretics and long-acting dihydropyridine calcium channel blockers may also be useful in the prevention of coronary events. However, a large body of information indicates the benefit of angiotensin-converting enzyme inhibitors, antiplatelet agents, β blockers, and hypolipemic agents in patients with established disease.