In both the Global Registry of Acute Coronary Events (GRACE)180 and ACTION- registries, for example, in-hospital mortality Rosendorff et al Treatment of Hypertension in Patients With CAD 1389 increased by 20% for every 10-mmHg decrease in BP at presentation. In contrast to the Thrombolysis in Myocardial Infarction risk score for UA/NSTEMI, in the Thrombolysis in Myocardial Infarction risk score for STEMI, SBP <100 mmHg emerged as a powerful contributor to the model, but hyperten- IntheGlobalUseofStrategiestoOpenOccluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) and Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) a very low SBP ( 90 mmHg) was strongly associated with 48-hour and 30-day mortality, but there was little differ- ence in mortality between patients who had a high SBP (>140 mmHg) and those with an SBP in the normal or prehyperten- sive range (121 140 mmHg). Even severe hypertension (up to an SBP of 200 mmHg) appeared to be protective in the NCDR ACTION analysis of 80000 patients with MI.181 Although uncontrolled hypertension does not appear to significantly increase in-hospital mortality in patients with ACS, it is a major risk factor for intracranial hemorrhage and thus remains a relative contraindication to fibrinolysis.176 When broader bleeding outcomes are evaluated across the ACS spectrum, a U-shaped association between BP and in- hospital bleeding is observed, with excess bleeding for both patients with hypertension and those with hypotension. In an analysis from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) bleeding rates were lowest in patients with admis- sion SBP between 120 and 180 mmHg and increased progres- sively with BPs above and below these ranges. 