Management of Uncontrolled Hypertension in Post-MI Patients with Angioplasty

Initial Evaluation and Treatment

The American College of Cardiology recommends that patients with a history of myocardial infarction (MI) and angioplasty who present with high systolic blood pressure and low diastolic blood pressure should first be evaluated for left ventricular function using echocardiography, as this hemodynamic pattern may indicate increased arterial stiffness or ventricular dysfunction, and pharmacological management depends critically on the ejection fraction 1.
In patients with left ventricular systolic dysfunction (FEVI <40%), the European Heart Society recommends the use of ACE inhibitors as first-line treatment, which should be initiated within the first 24 hours if systolic blood pressure is ≥100 mmHg or not more than 30 mmHg below the baseline value 2, 3, 4.
The American Heart Association recommends that beta-blockers should be used in patients with left ventricular systolic dysfunction, as they reduce mortality by 35% in these patients 7.

In patients with FEVI <40%, the European Heart Journal recommends the use of ACE inhibitors, beta-blockers, and high-intensity statins, and considers the use of aldosterone antagonists if the patient is already receiving ACE inhibitors and beta-blockers 2, 3, 4, 6.
In patients with FEVI ≥40%, the American College of Cardiology recommends the use of ACE inhibitors, high-intensity statins, and beta-blockers if there is angina present 2, 3, 9.

The European Heart Journal recommends the use of high-intensity statins, such as atorvastatin 80 mg daily, in all patients with a history of MI, with a target LDL-C level of <70 mg/dL or a reduction of ≥50% from the baseline value 3, 4, 1.
The American Heart Association recommends the use of antiplatelet therapy, such as aspirin 75-100 mg daily, indefinitely, and dual antiplatelet therapy (aspirin + ticagrelor or prasugrel) for 12 months after angioplasty 3, 4.

The European Heart Journal recommends that patients should undergo echocardiography during hospitalization to evaluate left ventricular function and exclude ventricular thrombus, and that renal function and electrolytes should be monitored before initiating ACE inhibitors 3, 4.
The American College of Cardiology recommends that patients should be reevaluated at 40 days and 3 months after discharge to consider the use of an implantable cardioverter-defibrillator (ICD) if left ventricular function remains ≤35% 5, 6, 1.