Table 10.

BIHS position: Considerations for blood pressure (BP) lowering therapy in acute coronary syndrome (ACS).

Hypertensive emergency state	Acute coronary syndrome
Speed of BP reduction and BP targets	1. Routine immediate reduction in BP is not recommended. Adequate analgesia and maintenance of oxygenation are first steps
	2. Prioritise revascularisation therapy over BP therapy
	3. Reduce BP as indicated by clinical scenario (example as per procedural requirements in the cardiac catheterisation laboratory) in patients with ACS. Do not reduce DBP below 70 mmHg.
	4. All patients should have plans drawn for long term hypertension management (<140/90 mmHg prior to discharge).
Medications	IV GTN and/or IV labetalol may be used. Nitroprusside to be avoided in ACS.