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{{Chronic stable angina}}
{{Chronic stable angina}}


'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan. M.B.B.S.]]
'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-In-Chief:''' [[Lakshmi Gopalakrishnan|Lakshmi Gopalakrishnan. M.B.B.S.]]; {{AA}}


==Overview==
==Overview==
The risk of progression of [[atherosclerosis]] is proportional to the increase in [[hypertension|elevated blood pressure]], [[hyperglycemia]] and [[dyslipidemia]]. Therefore, the control of [[hypertension]], [[hyperglycemia]] and other features of [[metabolic syndrome]] deserves special attention in the prevention of mortality and morbidity due to [[coronary artery disease]]. In patients with established [[CAD]], concomitant [[diabetes]] and/or [[renal dysfunction]], the blood pressure goal is 130/80-85 and the decision to lower blood pressure depends on the total cardiovascular risk and the extent of target organ damage.<ref name="pmid12964575">De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12964575 European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice.] ''Eur Heart J'' 24 (17):1601-10. PMID: [http://pubmed.gov/12964575 12964575]</ref><ref name="pmid12777938">European Society of Hypertension-European Society of Cardiology Guidelines Committee (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12777938 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension.] ''J Hypertens'' 21 (6):1011-53. [http://dx.doi.org/10.1097/01.hjh.0000059051.65882.32 DOI:10.1097/01.hjh.0000059051.65882.32] PMID: [http://pubmed.gov/12777938 12777938]</ref> Close monitoring and [[Chronic stable angina risk factor modifications|lifestyle changes]] may be indicated in [[Chronic stable angina assessing the pretest probability of coronary artery disease#Calculating the pretest probability for coronary artery disease|low-risk patients]] without documented target organ damage. However, in [[Chronic stable angina assessing the pretest probability of coronary artery disease#Calculating the pretest probability for coronary artery disease|high-risk patients]] with a sustained [[Systolic blood pressure|SBP]] of ≥140mmHg and/or [[diastolic blood pressure|DBP]] ≥90mmHg, the goal is to lower blood pressure less than 140/90 with the help of combined [[Chronic stable angina pharmacotherapy overview|drug therapy]] and [[Chronic stable angina risk factor modifications|life style modification]]. Anti-hypertensive therapies that have shown to significantly reduce cardiovascular mortality and morbidity in patients with [[coronary artery disease]] include [[diuretics]], [[Chronic stable angina treatment beta blockers|beta-blockers]], [[Chronic stable angina treatment angiotensin converting enzyme inhibitors (ACEI) and renin angiotensin aldosterone system blockers (RAAS blockers)|ACEIs, ARBs]] and [[Chronic stable angina treatment calcium channel blockers|calcium channel blockers]].
The risk of progression of [[atherosclerosis]] is proportional to the increase in [[hypertension|elevated blood pressure]], [[hyperglycemia]] and [[dyslipidemia]]. Therefore, the control of [[hypertension]], [[hyperglycemia]] and other features of [[metabolic syndrome]] deserves special attention in the prevention of mortality and morbidity due to [[coronary artery disease]]. In patients with established [[CAD]], concomitant [[diabetes]] and/or [[renal dysfunction]], the blood pressure goal is 130/80-85 and the decision to lower blood pressure depends on the total cardiovascular risk and the extent of target organ damage.<ref name="pmid12964575">De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12964575 European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice.] ''Eur Heart J'' 24 (17):1601-10. PMID: [http://pubmed.gov/12964575 12964575]</ref><ref name="pmid12777938">European Society of Hypertension-European Society of Cardiology Guidelines Committee (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12777938 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension.] ''J Hypertens'' 21 (6):1011-53. [http://dx.doi.org/10.1097/01.hjh.0000059051.65882.32 DOI:10.1097/01.hjh.0000059051.65882.32] PMID: [http://pubmed.gov/12777938 12777938]</ref> Close monitoring and [[Chronic stable angina risk factor modifications|lifestyle changes]] may be indicated in [[Chronic stable angina assessing the pretest probability of coronary artery disease#Calculating the pretest probability for coronary artery disease|low-risk patients]] without documented target organ damage. However, in [[Chronic stable angina assessing the pretest probability of coronary artery disease#Calculating the pretest probability for coronary artery disease|high-risk patients]] with a sustained [[Systolic blood pressure|SBP]] of ≥140 mm Hg and/or [[diastolic blood pressure|DBP]] ≥90 mm Hg, the goal is to lower blood pressure less than 140/90 with the help of combined [[Chronic stable angina pharmacotherapy overview|drug therapy]] and [[Chronic stable angina risk factor modifications|life style modification]]. Anti-hypertensive therapies that have shown to significantly reduce cardiovascular mortality and morbidity in patients with [[coronary artery disease]] include [[diuretics]], [[Chronic stable angina treatment beta blockers|beta-blockers]], [[Chronic stable angina treatment angiotensin converting enzyme inhibitors (ACEI) and renin angiotensin aldosterone system blockers (RAAS blockers)|ACEIs, ARBs]] and [[Chronic stable angina treatment calcium channel blockers|calcium channel blockers]].


==Guide to Blood Pressure Management adapted from the European Task Force<ref name="pmid12964575">De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12964575 European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice.] ''Eur Heart J'' 24 (17):1601-10. PMID: [http://pubmed.gov/12964575 12964575]</ref>==
==Blood Pressure Control==
===Guide to Blood Pressure Management adapted from the European Task Force<ref name="pmid12964575">De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12964575 European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice.] ''Eur Heart J'' 24 (17):1601-10. PMID: [http://pubmed.gov/12964575 12964575]</ref>===
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[[Image:European task force- Blood pressure management.JPG|650px|center]]}}
[[Image:European task force- Blood pressure management.JPG|650px|center]]}}


==2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>==
==2012 Chronic Angina Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)==


===Blood Pressure Control (DO NOT EDIT) <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>===
===Blood Pressure Control (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210  }} </ref>===


{|class="wikitable"
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients should initiate and/or maintain lifestyle modifications such as [[Chronic stable angina treatment weight management|weight control]]; increased [[Chronic stable angina treatment physical activity|physical activity]]; moderation of alcohol consumption; limited sodium intake; and maintenance of a diet high in fresh fruits, vegetables, and low-fat dairy products. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' All patients should be counseled about the need for lifestyle modification: weight control; increased physical activity; alcohol moderation; sodium reduction; and emphasis on increased consumption of fresh fruits, vegetables, and low-fat dairy products. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Blood pressure|Blood pressure control]] according to Joint National Conference VII guidelines is recommended (i.e., [[blood pressure]] less than 140/90 mm Hg or less than 130/80 mm Hg for patients with [[diabetes]] or [[chronic kidney disease]]). <ref name="pmid14656957">Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14656957 Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.] ''Hypertension'' 42 (6):1206-52. [http://dx.doi.org/10.1161/01.HYP.0000107251.49515.c2 DOI:10.1161/01.HYP.0000107251.49515.c2] PMID: [http://pubmed.gov/14656957 14656957]</ref>  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In patients with SIHD with blood pressure 140/90 mm Hg or higher, antihypertensive drug therapy should be instituted in addition to or after a trial of lifestyle modifications ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' For [[hypertension|hypertensive patients]] with well established [[coronary artery disease]], it is useful to add [[blood pressure]] medication as tolerated, treating initially with [[Chronic stable angina treatment beta blockers|beta blockers]] and/or [[Chronic stable angina treatment angiotensin converting enzyme inhibitors (ACEI) and renin angiotensin aldosterone system blockers (RAAS blockers)|ACE inhibitors]], with addition of other drugs as needed to achieve target [[blood pressure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' The specific medications used for treatment of high blood pressure should be based on specific patient characteristics and may include angiotensin-converting enzyme (ACE) inhibitors and/or beta blockersblockers, with addition of other drugs, such as thiazide diuretics or calcium channel blockers, if needed to achieve a goal blood pressure of less than 140/90 mm Hg. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}
==Related Chapters==
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
==Sources==
*[http://circ.ahajournals.org/content/99/21/2829.full.pdf The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina]<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>
*[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina]<ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>
*[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina]<ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>
*[http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology]<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref>


==References==
==References==
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Latest revision as of 16:04, 31 October 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan. M.B.B.S.; Aysha Anwar, M.B.B.S[2]

Overview

The risk of progression of atherosclerosis is proportional to the increase in elevated blood pressure, hyperglycemia and dyslipidemia. Therefore, the control of hypertension, hyperglycemia and other features of metabolic syndrome deserves special attention in the prevention of mortality and morbidity due to coronary artery disease. In patients with established CAD, concomitant diabetes and/or renal dysfunction, the blood pressure goal is 130/80-85 and the decision to lower blood pressure depends on the total cardiovascular risk and the extent of target organ damage.[1][2] Close monitoring and lifestyle changes may be indicated in low-risk patients without documented target organ damage. However, in high-risk patients with a sustained SBP of ≥140 mm Hg and/or DBP ≥90 mm Hg, the goal is to lower blood pressure less than 140/90 with the help of combined drug therapy and life style modification. Anti-hypertensive therapies that have shown to significantly reduce cardiovascular mortality and morbidity in patients with coronary artery disease include diuretics, beta-blockers, ACEIs, ARBs and calcium channel blockers.

Blood Pressure Control

Guide to Blood Pressure Management adapted from the European Task Force[1]

“
”

2012 Chronic Angina Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)

Blood Pressure Control (DO NOT EDIT)[3]

Class I
"1. All patients should be counseled about the need for lifestyle modification: weight control; increased physical activity; alcohol moderation; sodium reduction; and emphasis on increased consumption of fresh fruits, vegetables, and low-fat dairy products. (Level of Evidence: B)"
"2. In patients with SIHD with blood pressure 140/90 mm Hg or higher, antihypertensive drug therapy should be instituted in addition to or after a trial of lifestyle modifications (Level of Evidence: A)"
"3. The specific medications used for treatment of high blood pressure should be based on specific patient characteristics and may include angiotensin-converting enzyme (ACE) inhibitors and/or beta blockersblockers, with addition of other drugs, such as thiazide diuretics or calcium channel blockers, if needed to achieve a goal blood pressure of less than 140/90 mm Hg. (Level of Evidence: B)"

References

  1. ↑ 1.0 1.1 De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J et al. (2003) European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 24 (17):1601-10. PMID: 12964575
  2. ↑ European Society of Hypertension-European Society of Cardiology Guidelines Committee (2003) 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 21 (6):1011-53. DOI:10.1097/01.hjh.0000059051.65882.32 PMID: 12777938
  3. ↑ Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP; et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): 3097–137. doi:10.1161/CIR.0b013e3182776f83. PMID 23166210.

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