Target levels of blood pressure in patients with arterial hypertension and coronary heart disease

High blood pressure (BP) is a leading risk factor for premature death and one of the important risk factors for coronary heart disease (CHD). A significant increase in risk is observed starting from the level of systolic BP of about 140 mm Hg. Tactics of antihypertensive therapy in patients with co-existent hypertension (HTN) and CHD are reviewed in the European and Russian recommendations for HTN. In spite of this, some uncertainty remains regarding the optimal target BP level in patients with HTN and clinically manifest CHD mainly due to the lack of convincing evidence arising from large and specially designed randomized clinical trials (RCTs) dedicated to this issue. Some observational studies, meta-analysis, special analysis of subgroups of patients with HTN and CHD from the large RCTs, showed a J-shaped relation between the achieved BP and an increased cardiovascular risk. Our paper reviews up-to-date literature in relation to the target BP level in patients with HTN and CHD, including patients with high cardiovascular risk and patients undergoing revascularization. We review data from large studies and meta-analysis, evaluating the impact of more intensive vs. less intensive control of BP on the risk of major cardiovascular events or mortality. The analysis of the literature confirmed a lack of evidence of benefits of lower target BP values in senile patients with co-existent HTN and CHD, thus indicating the need for well-planned RCTs.

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