Hypertension

Hypertension causes atheroma formation and atherosclerosis.
A significant number of patients with angina
have hypertension: blood pressure greater than 140 or
pressures in the high normal range of 135–140 systolic
mmHg. Hypertension causes an increased thickness of the
left ventricular muscle, which requires more blood and
oxygen to function. Hypertension must be aggressively
controlled. The best antihypertensive agents for patients
with angina are beta-blockers and ACE inhibitors.
ACE inhibitors are particularly useful because they
dilate the arterial circulation and rest the myocardium
without stimulating the heart to beat at a faster rate or to
require more oxygen. Other vasodilators that include
1-
adrenergic blockers, such as terazosin, increase heart rate
and ejection velocity and are contraindicated in patients
with CAD. These agents may increase the incidence of
heart failure. A randomized clinical trial the HOPE study;
see the Bibliography indicates that ACE inhibitors improve
survival in patients with CAD.

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