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 greater than or equal to 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 less than 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 less than 180 mg/dL while avoiding
hypoglycemiaa for hospitalized patients with UA/NSTEMI with either a
complicated or uncomplicated course. (IIa-B)
a
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There is uncertainty about the ideal target range for glucose necessary to achieve an optimal riskbenefit ratio.
