既知冠動脈疾患患者も血圧140/90を降圧目標に ：AHA/ACC/ASH共同ステートメント

American Heart Association (AHA)、American College of Cardiology (ACC)、American Society of Hypertension (ASH)による新しいステートメント

既知冠動脈疾患患者も血圧140/90を降圧目標に

Treatment of Hypertension in Patients With Coronary Artery Disease A Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension
http://hyper.ahajournals.org/content/early/2015/03/30/



以前は、130/80ｍｍHg未満がターゲットであったが、エビデンスレベルが低く、再評価したところ、上記基準緩和となった。

60歳を超えた場合、拡張期血圧を60ｍｍHg未満に下げることなく、緩徐に降圧を行うことも記載

血圧目標	条件	エビデンスレベル
<150>	80歳超	IIa/B
<140>	CAD	I/A
	ACS	IIa/C
	HF	IIa/B
<130>	CAD	IIb/C
	心筋梗塞後	IIb/C
	卒中/TIA
	冠動脈疾患
	PAD,AAA

非合併症高血圧では、β遮断剤はもはやその役割の終焉をむかえているが 、冠動脈疾患存在下では、リンボー（辺土）からセンターステージへ、すなわち、この場合は（禁忌が無い限り）β遮断剤を含まなければならないと・・・
http://www.medpagetoday.com/Cardiology/Hypertension/50760

---

β遮断剤の項目が効くなぁ・・・

冠動脈疾患・β遮断剤の項目をみるとそこまで極端な表現じゃないようだけど・・・

The decreased heart rate increases diastolic filling time for coronary perfusion.  β -Blockers also inhibit renin release from the juxtaglomerular apparatus. 

Cardioselective ( β 1) agents without intrinsic sympathomimetic activity are used most frequently. Relative contraindications to their use include significant sinus or atrioventricular node dysfunction, hypotension, decompensated HF, and severe bronchospastic lung disease.
 

 PAD is rarely made symptomatically worse by the use of these agents, and mild bronchospastic disease is not an absolute contraindication. Caution is needed when brittle diabetic patients with a history of hypoglycemic events are treated because β -blockers may mask the symptoms of hypoglycemia. 

 Recently, there has been considerable controversy concerning the appropriateness of using β -blockers as first-line therapy in hypertension in those patients who do not have a compelling indication; however, their use in patients with angina, prior MI, or HF has a solid basis of positive data.  β -Blockers should be prescribed as initial therapy for the relief of symptoms in patients with stable angina.  β -Blockers may be considered as long-term therapy for all other patients with coronary or other vascular disease. Recent ACC Foundation/AHA guidelines 169,170 have recommended β -blocker therapy in patients with normal LV function after MI or ACS (Class I; Level of Evidence B), specifically carvedilol, metoprolol succinate, or bisoprolol, in all patients with LV systolic dysfunction (ejec tion fraction ≤ 40%) or with HF or prior MI unless contrain - dicated (Class I; Level of Evidence A).  β -Blockers should be started and continued for 3 years in all patients with normal LV function after MI or ACS (Class I; Level of Evidence B).  168–17