24
Treatment
Î For patients who do not tolerate statins, low-density lipoprotein
cholesterol (LDL-C)–lowering therapy with bile acid sequestrants,
a
niacin,
b
or both is reasonable. (IIa-B)
a
e use of bile acid sequestrant is relatively contraindicated when triglycerides are ≥200 mg/dL and is
contraindicated when triglycerides are ≥500 mg/dL.
b
Dietary supplement niacin must not be used as a substitute for prescription niacin.
Blood Pressure Management
Î All patients should be counseled about the need for lifestyle
modification: weight control; increased physical activity; alcohol
moderation; sodium reduction; and emphasis on increased
consumption of fresh fruits, vegetables, and low-fat dairy products.
(I-B)
Î In patients with SIHD with BP ≥140/90 mm Hg, antihypertensive drug
therapy should be instituted in addition to or after a trial of lifestyle
modifications. (I-A)
Î The specific medications used for treatment of high BP should be
based on specific patient characteristics and may include angiotensin-
converting enzyme (ACE) inhibitors and/or beta blockers with the
addition of other drugs, such as thiazide diuretics or calcium channel
blockers, if needed to achieve a goal BP of <140/90 mm Hg. (I-B)
Table 11. Indications for Individual Drug Classes in the
Treatment of Hypertension in Patients With SIHD*
Indication
Recommended Drugs
Diuretic
Beta
Blocker
ACE
Inhibitor ARB
Calcium-
Channel
Blocker
Aldosterone
Antagonist
Heart failure
✔ ✔ ✔ ✔ ✔
LV dysfunction
✔ ✔
Aer myocardial
infarction
✔ ✔ ✔ ✔
Angina
✔ ✔
Diabetes mellitus
✔ ✔ ✔
Chronic kidney
disease
✔ ✔
* Table indicates drugs that should be considered and does not indicate that all drugs should
necessarily be prescribed in an individual patient (eg, ACE inhibitors and angiotensin-receptor
blockers (ARBs) typically are not prescribed together).
