Journal of Coronary Artery Disease
Online ISSN : 2434-2173

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Optimal Hypertensive Treatment for Reduction in Progression and Onset in Patients with Chronic Coronary Syndrome
Koji HiguchiMitsuru Ohishi
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JOURNAL OPEN ACCESS Advance online publication

Article ID: 30.24-00007

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Abstract

The importance of optimal medical therapy for chronic coronary syndrome was demonstrated in the COURAGE and ISCHEMIA trials. Hypertension is an important risk factor for atherosclerotic disease; however, it has not garnered as much attention as low-density lipoprotein cholesterol in coronary artery diseases. Blood pressure contributes significantly to the development of atherosclerosis, an underlying pathological mechanism of chronic coronary syndrome. This is due to shear stress, which causes endothelial dysfunction and angiotensin II-induced intimal smooth muscle cell proliferation. Although the renin-angiotensin system plays an important role in atherosclerosis, the strong expression of angiotensin-converting enzyme in macrophages and angiotensin II type 1 receptors in smooth muscle cells suggests that this pathway may be involved in different local pathologies. Furthermore, an imbalance between myocardial oxygen demand and supply contributes to chronic coronary syndromes. An elevated systolic blood pressure also has a significant impact on increased myocardial oxygen consumption. Therefore, adequate blood pressure reduction is important to prevent the development of chronic coronary syndrome. Percutaneous coronary intervention, which significantly contributes to the treatment of chronic coronary syndrome, requires aggressive antithrombotic therapy. Although antithrombotic therapy has significantly increased the success rate, it is also associated with an increase in the incidence of serious adverse bleeding events. A bleeding with antithrombotic therapy study conducted in Japan reported that a robust antihypertensive regimen could reduce the incidence of intracranial hemorrhaging. Percutaneous coronary intervention for chronic coronary syndrome is an elective procedure that should be performed only after adequate blood pressure reduction has been achieved.

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© 2024 The Japanese Coronary Association

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