UA/NSTEMI

Treatment Blood Pressure Control ÎÎBlood pressure control according to JNC 7 guidelines is recommended (ie, blood pressure <140/90 mm Hg or <130/80 mm Hg if the patient has diabetes mellitus or CKD). (I-A) ÎÎAdditional measures recommended to treat and control blood pressure include the following: •  Patients should initiate and/or maintain lifestyle modifications, including 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) •  For patients with blood pressure ≥140/90 mm Hg (or ≥130/80 mm Hg for individuals with CKD or diabetes mellitus), it is useful to add blood pressure medication as tolerated, treating initially with beta blockers and/or ACE inhibitors, with addition of other drugs such as thiazides as needed to achieve target blood pressure. (I-A) Diabetes Mellitus ÎÎDiabetes management should include lifestyle and pharmacotherapy measures to achieve a near-normal HbA1c level of <7%. (I-B) ÎÎDiabetes management should also include the following: •  Initiate and maintain vigorous modification of other risk factors (eg, physical activity, weight management, blood pressure control, and cholesterol management) as recommended. (I-B) •  It is useful to coordinate the patient's diabetic care with the patient's primary care physician or endocrinologist. (I-C) ÎÎMedical treatment in the acute phase of UA/NSTEMI and decisions on whether to perform stress testing, angiography, and revascularization should be similar in patients with and without diabetes mellitus. (I-A) ÎÎFor patients with UA/NSTEMI and multivessel disease, CABG with use of the internal mammary arteries can be more beneficial than PCI in patients being treated for diabetes mellitus. (IIa-B) ÎÎPCI is reasonable for UA/NSTEMI patients with diabetes mellitus with single-vessel disease and inducible ischemia. (IIa-B) ÎÎIt is reasonable to use an insulin-based regimen to achieve and maintain glucose levels <180 mg/dL while avoiding hypoglycemiaa for hospitalized patients with UA/NSTEMI with either a complicated or uncomplicated course. (IIa-B) a There is uncertainty about the ideal target range for glucose necessary to achieve an optimal riskbenefit ratio. 38

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