Statement on treating patients with hypertension and heart failure

When treating patients with hypertension and heart failure, providers should incorporate an exercise program and monitor risk factors such as dyslipidemia, obesity, diabetes and smoking, according to a scientific statement from three leading medical organizations. Most patients are also advised to take a beta-blocker by itself or in combination with another class of drugs.

The statement from the American Heart Association (AHA), American College of Cardiology (ACC) and American Society of Hypertension (ASH) updated guidelines from 2007.

The authors mentioned the AHA, ACC and ASH are in the process of putting together a guideline for the primary prevention of hypertension. This statement was intended for the secondary prevention of hypertension and in patients with CAD and to offer evidence-based recommendations on which antihyperintensive medications to use.

To lower blood pressure, the authors recommended treatment with ACE inhibitors, ARBs, beta-blockers and aldosterone receptor antagonists. For patients with severe heart failure or severe renal impairment, they suggested using loop diuretics in combination with an ACE inhibitor or ARB and a beta-blocker.

The authors defined hypertension as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg and/or the current use of antihypertensive medications. An estimated 65 million people, or approximately one-fourth of U.S. adults, have hypertension.

They said the target blood pressure should be <140/90 mmHg, although they said to consider lowering blood pressure to <130/80 mmHg in some cases, particularly for people who have had a stroke, heart attack or transient ischemic attack or have another cardiovascular condition. They also recommended slowly lowering blood pressure for patients with an elevated diastolic blood pressure who had CAD or heart failure and evidence of myocardial ischemia.

The scientific statement is not intended for children. It also did not evaluate various modes of assessing blood pressure, including 24-hour ambulatory blood pressure monitoring.

The statement was published in the March 31 edition of Hypertension, an AHA journal.