Assess and treat high blood pressure status in patients with IHD.

Hypertension is a risk factor for developing cardiovascular disease, the risk increasing in proportion to the severity of the hypertension, as demonstrated in multiple observational studies. Treatment of hypertension results in reduction in coronary events, even with mild hypertension or in older populations. The most evidence from hypertension trials to support prevention of coronary events exists for beta-blockers and diuretics. In patients with hypertension and IHD, beta-blockers are preferred first-line agents as they provide additional therapeutic benefit - particularly in patients with prior MI and/or angina. See the VHA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension in the Primary Care Setting.

Several trials in elderly patients also demonstrated clinically significant reductions in IHD and death, including the SHEP (1989) and STOP-Hypertension trials (1991). Treatment benefits have been extended to mild hypertension (MRC, 1985). In the Treatment of Mild Hypertension Study (Neaton et al., 1993), the average entry blood pressure was 140/91. After an average of 4.4 years of treatment, there was a relative risk reduction of 0.66 (p=0.03) for combined cardiovascular events (i.e., MI, stroke, angina, claudication, arterial occlusive disease, and transient ischemic attack requiring hospitalization). A meta-analysis by Gueyffier et al. (1997) of hypertension treatment trials confirmed the reduction in coronary events.