The majority will respond to standard methods of hypertension control. To control BP, specific agents should be selected that have an established evidence base for risk reduction in ACS. These agents include -blockers, ACE inhibitors or ARBs, and, in selected patients, aldosterone antagonists. Although nitrates do not change the natural history of ACS, they are very useful for hypertensive patients with ACS, particularly if there is ongoing ischemia or pulmonary congestion. Particular care should be taken to avoid hypotension, with the risk of worsening myocardial ischemia. The benefits of treating hypertension in the ACS setting are logical, but perhaps the major impact on long-term morbidity and mortality depends on the efficacy of continued outpatient BP control once effec- tive therapy has been initiated in hospital. 1. If there is no contraindication to the use of - blockers, in patients with ACS, the initial therapy of hypertension should include a short-acting 1 - selective -blocker without intrinsic sympathomi- metic activity (metoprolol tartrate or bisoprolol). -Blocker therapy should typically be initiated orally within 24 hours of presentation (Class I; Level of Evidence A). For patients with severe hy- pertension or ongoing ischemia, an intravenous -blocker (esmolol) can be considered (Class IIa; Level of Evidence B). For hemodynamically un- stable patients or when decompensated HF exists, the initiation of -blocker therapy should be de- layed until stabilization has been achieved (Class I; Level of Evidence A). 2. In patients with ACS and hypertension, nitrates should be considered to lower BP or to relieve on- going ischemia or pulmonary congestion (Class I; Level of Evidence C). Nitrates should be avoided in patients with suspected right ventricular infarc- tion and in those with hemodynamic instability. 