For people with hypertension, doctors usually aim to get their blood pressure down to 140/90 or lower. However, that may not be good enough for people with coronary artery disease.

The progression of coronary artery disease is lowest for patients with blood pressure below 120/80, according to a report in the Journal of the American College of Cardiology.

“We think that now it is the time to discover the optimal standards for blood pressure reduction for patients with coronary disease,” Dr. Ilke Sipahi of the Cleveland Clinic Foundation, Ohio told Reuters Health. “It is likely that within the next few years we will realize that we have been treating blood pressure too conservatively.”

A blood pressure reading includes two numbers: the upper number indicates the pressure when the heart contracts, the lower number shows the pressure when the heart relaxes between beats.

Sipahi and colleagues evaluated the effects of normal blood pressure (up to 120/80), prehypertension (120/80 to 140/90), and hypertension (above 140/90) on the build-up of plaque, or atherosclerosis, in the coronary arteries.

They found that over a 2-year period, the amount of plaque increased by an average of 12 cubic millimeters in hypertensive patients, and barely increased for prehypertensive subjects. Patients with normal blood pressure had a decrease in plaque volume of 4.6 cubic millimeters.

Patients who dropped their blood pressure from prehypertensive to normal levels during the study had a decrease in atheroma volume averaging 6.2 cubic millimeters, the researchers note.

Thus, said Sipahi, blood pressure levels below 120/80 “are the best to slow progression of atherosclerosis.” These levels, he added, “were even associated with a strong trend for reversal of coronary disease.”

In an accompanying editorial, Drs. Jonathan Tobis and Gregg C. Fonarow of the University of California, Los Angeles say that the findings point to “a critical need to reassess the guidelines for managing blood pressure in patients with coronary artery disease.”

“Perhaps what has traditionally been considered ‘normal’ blood pressure is not necessarily optimal nor healthy in patients with coronary artery disease,” the editorial concludes.

SOURCE: Journal of the American College of Cardiology, August 15, 2006.