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Intensive antihypertensive treatment to the new lower blood pressure targets
1Department of Preventive Medicine, RUSH Medical College of RUSH University, 1725 West Harrison Street, Suite 117, Chicago, IL 60612, USA.
Insights
Lowering blood pressure to less than 150/85 mm Hg in patients with type II diabetes significantly reduces cardiovascular events. This intensive blood pressure management also improves quality of life and offers economic benefits.
Area of Science:
- Cardiology
- Hypertension Research
- Diabetes Management
Background:
- Authoritative bodies recommend lower blood pressure goals for high-risk hypertension.
- Recent randomized clinical trials validate these lower targets.
Purpose of the Study:
- To assess the impact of lower blood pressure goals on cardiovascular outcomes in high-risk patients, particularly those with diabetes.
- To evaluate the quality-of-life and economic implications of intensive blood pressure management.
Main Methods:
- Analysis of data from the Hypertension Optimal Treatment (HOT) trial and the United Kingdom Prospective Diabetes Study (UKPDS 38).
- Inclusion of a quality-of-life substudy from the HOT trial.
- Economic analyses evaluating cost-effectiveness.
Main Results:
- Diabetic patients in the HOT trial showed the best prognosis when treated to a diastolic blood pressure of 80 mm Hg.
- Patients with type II diabetes in UKPDS 38 experienced major reductions in cardiovascular events with a goal of <150/85 mm Hg.
- The HOT trial quality-of-life substudy indicated greatest improvement in patients treated to ≤80 mm Hg diastolic blood pressure.
Conclusions:
- Lowering blood pressure to intensive goals is effective in reducing cardiovascular risk in high-risk hypertensive patients, especially those with diabetes.
- Achieving lower blood pressure targets improves patient quality of life.
- Intensive blood pressure management is economically beneficial, reducing overall healthcare expenditures.
Abstract:
The recommendations of several authoritative bodies that blood pressure be lowered to lower-than-traditional goals in patients with high-risk hypertension have recently been validated by data from several randomized clinical trials. In the Hypertension Optimal Treatment (HOT) trial, the best prognosis was in diabetic patients treated to a diastolic blood pressure of 80 mm Hg. In the United Kingdom Prospective Diabetes Study 38, a major reduction in nearly every type of cardiovascular event was noted among patients with type II diabetes who were treated to the lower blood pressure goal of less than 150/85 mm Hg. In the quality-of-life substudy of the HOT trial, the greatest improvement was found in patients treated to the lowest diastolic blood pressure goal of less than or equal to 80 mm Hg. Two economic analyses suggest that attainment of the lower blood pressure goal not only is possible and effective in reducing cardiovascular risk but also saves money overall by reducing expenditures for stroke, myocardial infarction, and other cardiovascular events.