The vast majority of hyperten- sive individuals, including those with overt cardiac disease, will not experience problems related to lowering of DBP when standard antihypertensive medications are used. Concerns that coronary perfusion is limited by an autoregulatory threshold have not yet been validated in humans with healthy or even diseased coronary arteries, and no consensus exists on the min- imum safe level of DBP in these individuals.Although an auto- regulatory threshold has not been defined in humans, with or without CAD, it is clear, mainly fromACCORD, that lower BP targets, down to levels <120/80 mmHg, protect against stroke and do not significantly increase CAD events. Most studies that have addressed lower BP targets have achieved DBP val- ues in the 70- to 79-mmHg range, which appears to be safe. Therefore, a reasonable recommendation would be a BP target of <140/90 mmHg for the secondary prevention of car- diovascular events in patients with CAD. However, there are some epidemiological data, several post hoc analyses of clini- cal trials, and a plethora of other data that support, but do not prove, that a lower target (<130/80 mmHg) may be appropri- ate in some individuals with CAD. We counsel that the BP should be lowered slowly in patients with occlusive CAD with evidence of myocardial ischemia, and caution is advised in inducing decreases in DBP to <60 mmHg, particularly if the patient is >60 years of age. In older hypertensive individu- als with wide pulse pressures, lowering SBP may cause very low DBP values (<60 mmHg). This should alert the clinician to assess carefully any untoward signs or symptoms, espe- cially those resulting from myocardial ischemia. 