Epidemiological studies suggest a strong association between hypertension and ischaemic heart disease (IHD), and hypertension is a major independent risk factor for the development of cardiovascular disease (CVD), including myocardial infarction (MI). Increased blood pressure (BP) also enhances coronary arteriosclerosis, and the combination of myocardial and coronary effects increases the risk of myocardial infarction and arrhythmias. The primary objective of the management of hypertension in patients with IHD is modification of the balance between myocardial oxygen supply and demand to improve the symptoms and reduce future cardiovascular adverse events. This review discusses which antihypertensive drugs should be used in patients who have been diagnosed with IHD with angina pectoris, in those with acute coronary syndromes and MI. Appropriate management should include beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and calcium channel blockers. In post-acute coronary syndrome (ACS) patients, a J- or U-shaped curve association existed between BP and the risk of future cardiovascular events, which suggests that too low a pressure may be dangerous in patients with a severe form of coronary atherosclerosis.