Lifestyle changes and the adoption of a heart healthy approach are critical, with the usual attention to diet, sodium intake, mod- eration of alcohol intake, regular exercise, weight loss, smoking cessation, glycemic control, lipid management, and antiplate- let therapy. Recognition and treatment of hypothyroidism and obstructive sleep apnea are important adjuncts in at-risk patients. Pharmacological management is inevitably required. A reasonable BP target for hypertensive patients with dem- onstrated CAD is <140/90 mmHg.20,155,159 167 A lower target BP (<130/80 mmHg) may be appropriate in some individuals with CAD or those with previous MI, stroke or transient isch- emic attack, or CAD risk equivalents (carotid artery disease, PAD, abdominal aortic aneurysm). 4.1. Pharmacological Therapy -Blockers are the drugs of first choice for the treatment of hypertension in patients with CAD that causes angina.168,169 They alleviate ischemia and angina primarily as a function of their negative inotropic and chronotropic actions. The decreased heart rate increases diastolic filling time for coro- nary perfusion. -Blockers also inhibit renin release from the juxtaglomerular apparatus. Cardioselective ( 1 ) agents without intrinsic sympathomimetic activity are used most fre- quently. Relative contraindications to their use include signifi- cant sinus or atrioventricular node dysfunction, hypotension, decompensated HF, and severe bronchospastic lung disease. PAD is rarely made symptomatically worse by the use of these agents, and mild bronchospastic disease is not an abso- lute contraindication. Caution is needed when brittle diabetic patients with a history of hypoglycemic events are treated because -blockers may mask the symptoms of hypoglycemia. Recently, there has been considerable controversy concern- ing the appropriateness of using -blockers as first-line therapy in hypertension in those patients who do not have a compel- ling indication; however, their use in patients with angina, prior MI, or HF has a solid basis of positive data. 