Particular caution is needed with regard to hypokalemia, which may precipitate arrhythmias Loop diuretics are preferred over thiazide and thia- zide-type diuretics for patients with ACS who have HF (NYHA class III or IV) or for patients with CKD and an estimated glo- merular filtration rate of <45 mL/min. 5.4. Safety of Anticoagulation in Patients With Uncontrolled Hypertension ACS therapy includes several strategies that involve platelet inactivation and anticoagulation to reduce the risk of thrombosis and poor clinical outcomes. The relative efficacy and safety of anticoagulant and antiplatelet therapy do not differ substantially in patients with STEMI, NSTEMI, or UA. In the ACS popula- tion, these drugs are most effective when given early. These ther- apies can lead to major bleeding complications, most commonly in the gastrointestinal tract and at the site of femoral access for percutaneous coronary interventions. Most concerning is that, in the setting of uncontrolled hypertension, the risk of hemor- rhagic stroke is increased.208 This provides another rationale for the aggressive control of hypertension in patients with ACS. Rapidly stabilizing patients to facilitate prompt coronary reperfusion is challenging in ACS patients with severe hyper- tension. Inherent to the use of medications largely limiting or disrupting intraluminal thrombus formation is the potential for severe secondary bleeding. The decision to pursue an inva- sive as opposed to a conservative approach should be based on standard clinical, demographic, and angiographic criteria. Although hypertension per se should not influence revascu- larization decisions other than indirectly in relation to factors such as renal function, it should be remembered that bleeding risks are notably higher with uncontrolled hypertension. Hypertension will continue to be highly prevalent among patients with ACS, particularly as the ACS population ages. The majority will respond to standard methods of hypertension control. 