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Stable Ischemic Heart Disease

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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).

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