Epidemiological studies suggest a strong association between hypertension and ischemic heart disease (IHD), and hypertension is a major independent risk factor for the development of cardiovascular disease (CVD) including myocardial infarction (MI) and stroke. 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 symptoms and reduce future cardiovascular adverse events. Patients with hypertension and heart failure constitute another important cohort in this high risk group. While several classes of antihypertensive agents have been shown to be beneficial in treating these patients, there are also several classes of drugs that should be avoided when treating hypertension in patients with IHD and heart failure. This review discusses which antihypertensive drugs should be used in patients who have established IHD with angina pectoris, in those with acute coronary syndromes and MI, and in those with heart failure. These recommendations are based on current guidelines. Finally, although there may be some differences in cardiovascular risk reduction among antihypertensive agents, the most important objective in hypertension management is to adequately control blood pressure irrespective of the agent used.