What is the first-line therapy for patients with hypertension and coronary artery disease (CAD)?

The first-line therapy for patients with hypertension and coronary artery disease (CAD) is a combination of beta-blockers with either ACE inhibitors or angiotensin receptor blockers (ARBs). This approach is preferred due to the unique benefits that beta-blockers provide in the context of CAD. They reduce the heart's workload and oxygen demand by lowering heart rate and myocardial contractility, which can help prevent angina and reduce the risk of arrhythmias.

ACE inhibitors also offer cardiovascular protection, particularly in patients with CAD, by helping to control blood pressure and reducing the workload on the heart. They have additional benefits, including improving endothelial function and reducing left ventricular hypertrophy, both of which are important for patients with CAD. Together, this combination effectively addresses both hypertension and the prevention of cardiac events related to CAD.

While other options such as diuretics or calcium channel blockers can be effective for managing hypertension, they do not provide the same cardiovascular protective effects that are crucial for patients also dealing with coronary artery disease. Therefore, the combination of beta-blockers and either ACE inhibitors or ARBs is the preferred and first-line strategy in this patient population.