Coronary heart disease and hypertension

NICE make no discrimination between target blood pressure if CHD or non-CHD (apart from specific targets for diabetes)

BP targets

• Clinical Blood pressure:
  
  
  • People aged under 80 years: lower than 140/90 mm Hg
    
    
  • People aged over 80 years: lower than 150/90 mm Hg
    
    
  • Daytime average APBM OR average HBPM blood pressure during persona's usual waking hours.
    • People aged under 80 years: lower than 135/85 mm Hg
    • People aged over 80 years: lower than 145/85 mm Hg.
• lower BP targets are recommended for those with diabetes in NICE diabetes guidelines
  • type 2 diabetes: <140/80mmHg, or <135/75mmHg if microalbuminuria or proteinuria is present
  • type 1 diabetes: <135/85mmHg, or <130/80mmHg with nephropathy
• patients who are at the highest baseline risk of CVD have the most to gain from lowering of BP. Although it may not be possible to achieve target in all patients, any lowering of BP is beneficial. Aim to achieve the largest reduction possible towards the target, taking into account tolerability and concordance for each individual patients (2)

Continuing treatment

• provide an annual review of care to monitor blood pressure, provide patients with support and discuss their lifestyle, symptoms and medication
• patients may become motivated to make lifestyle changes and want to stop using antihypertensive drugs. If at low cardiovascular risk and with well controlled blood pressure, these patients should be offered a trial reduction or withdrawal of therapy with appropriate lifestyle guidance and ongoing review

Please consult the complete guideline for more detailed advice

Reference:

1. NICE (August 2011). Clinical management of primary hypertension in adults