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The risk of progression of [[atherosclerosis]] is proportional to the increase in [[hypertension|elevated blood pressure]], [[hyperglycemia]] and [[dyslipidemia]]. Hence, control of [[hypertension]], [[hyperglycemia]] and other features of [[metabolic syndrome]] deserves special attention in the prevention of mortality due to [[coronary artery disease]]. In patients with established [[CAD]], the '''blood pressure goal is 130/85''' 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> 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 [[Chronic stable angina pharmacotherapy overview|drug therapy]] in addition to [[Chronic stable angina risk factor modifications|life style modifications]]. 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]]. Hence, control of [[hypertension]], [[hyperglycemia]] and other features of [[metabolic syndrome]] deserves special attention in the prevention of mortality due to [[coronary artery disease]]. In patients with established [[CAD]], the '''blood pressure goal is 130/85''' 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> 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 [[Chronic stable angina pharmacotherapy overview|drug therapy]] in addition to [[Chronic stable angina risk factor modifications|life style modifications]]. 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 based on 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>==
==Guide to Blood Pressure Management based on 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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Revision as of 15:32, 6 September 2011

Chronic stable angina Microchapters

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Classification

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Chronic Stable Angina
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan. M.B.B.S.

Overview

The risk of progression of atherosclerosis is proportional to the increase in elevated blood pressure, hyperglycemia and dyslipidemia. Hence, control of hypertension, hyperglycemia and other features of metabolic syndrome deserves special attention in the prevention of mortality due to coronary artery disease. In patients with established CAD, the blood pressure goal is 130/85 and the decision to lower blood pressure depends on the total cardiovascular risk and the extent of target organ damage.[1] 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 ≥140mmHg and/or DBP ≥90mmHg, the goal is to lower blood pressure less than 140/90 with the help of drug therapy in addition to life style modifications. 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.

Guide to Blood Pressure Management based on the European Task Force[1]

“
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ACC/AHA Guidelines- Cardiovascular Risk Factor Reduction- Blood Pressure Control (DO NOT EDIT)[2][3][4]

“

Class I

1. Patients should initiate and/or maintain lifestyle modifications such as weight control; increased physical activity; moderation of alcohol consumption; limited sodium intake; and maintenance of a diet high in fresh fruits, vegetables, and low-fat dairy products. (Level of Evidence: B)

2. 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). [5] (Level of Evidence: A)

3. For hypertensive patients with well established coronary artery disease, it is useful to add blood pressure medication as tolerated, treating initially with beta blockers and/or ACE inhibitors, with addition of other drugs as needed to achieve target blood pressure. (Level of Evidence: C)

”

Vote on and Suggest Revisions to the Current Guidelines

Sources

  • The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [2]
  • TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [3]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [4]
  • Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [6]

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. ↑ 2.0 2.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) 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. [1] PMID: 10351980
  3. ↑ 3.0 3.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) 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.[2] PMID: 12515758
  4. ↑ 4.0 4.1 Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)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.[3] PMID: 17998462
  5. ↑ Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. (2003) Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42 (6):1206-52. DOI:10.1161/01.HYP.0000107251.49515.c2 PMID: 14656957
  6. ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). [url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [4] "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"] Check |url= value (help). Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.


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