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Evidence for a lower target blood pressure for people with heart disease

Clive Rosendorff1, Henry R Black

  • 1Mount Sinai School of Medicine, New York, New York, USA. clive.rosendorff@va.gov

Current Opinion in Cardiology
|April 28, 2009
PubMed

Insights

Lowering blood pressure (BP) targets in hypertension management shows potential benefits. Current evidence suggests aggressive BP treatment is not harmful and may be beneficial, though more research is needed.

Area of Science:

  • Cardiology
  • Nephrology
  • Vascular Medicine

Background:

  • Current hypertension guidelines recommend a blood pressure (BP) target below 140/90 mmHg for all patients.
  • Lower BP targets (below 130/80 mmHg) are recommended for patients with diabetes, chronic kidney disease, coronary artery disease, and high cardiovascular risk (Framingham Risk Score ≥10%).

Purpose of the Study:

  • To review the evidence supporting the benefits of lower blood pressure targets in managing hypertension.
  • To evaluate the safety and efficacy of more aggressive blood pressure reduction strategies.

Main Methods:

  • Review of animal studies, clinical trials (surrogate and hard endpoints), and epidemiologic data.
  • Assessment of theoretical concerns regarding a J-shaped curve and myocardial ischemia risk with lower diastolic BP targets.

Main Results:

  • Evidence suggests that the theoretical risk associated with a J-shaped curve is not a significant concern.
  • Animal studies, clinical trials, and epidemiological data provide support against the risks of lowering BP aggressively.
  • Indirect evidence indicates potential benefits of lower BP targets.

Conclusions:

  • There is currently no evidence to suggest that more aggressive blood pressure treatment is harmful.
  • Substantial indirect evidence supports the potential benefits of lower blood pressure targets in hypertension management.
  • Clinical trials specifically designed to address the benefits of lower BP targets are ongoing.
Abstract

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