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Evidence for aggressive blood pressure-lowering goals in patients with coronary artery disease

Monisankar Roy1, Noman Mahmood, Clive Rosendorff

  • 1Mount Sinai School of Medicine, James J. Peters VA Medical Center, Bronx, NY 10468, USA. monisankar.roy@va.gov

Current Atherosclerosis Reports
|April 29, 2010
PubMed

Insights

Lowering blood pressure (BP) is crucial for cardiovascular health. This review examines evidence for lower BP targets, weighing benefits against potential risks like impaired coronary perfusion in specific patient groups.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Public Health

Background:

  • Elevated blood pressure (BP) is a primary risk factor for cardiovascular mortality and morbidity.
  • Current guidelines recommend differing BP targets based on patient complexity and comorbidities.
  • Controversy exists regarding the optimal BP target due to limited clinical trial data on hard endpoints.

Purpose of the Study:

  • To critically evaluate the evidence supporting lower blood pressure targets in hypertension management.
  • To assess the benefits of aggressive BP reduction against potential risks, particularly concerning coronary perfusion.

Main Methods:

  • Systematic review of epidemiological data and clinical studies.
  • Analysis of evidence from trials using surrogate and hard endpoints.
  • Consideration of patient-specific factors like left ventricular hypertrophy and coronary artery disease.

Main Results:

  • Strong epidemiological evidence supports lower BP targets.
  • Clinical studies with surrogate endpoints generally favor more intensive BP reduction.
  • Limited data from hard endpoint trials exist, raising concerns about overly aggressive diastolic BP lowering.

Conclusions:

  • The benefits of lowering blood pressure are well-established.
  • Further research with hard endpoints is needed to refine optimal BP targets, especially for high-risk patients.
  • Balancing BP reduction benefits with potential risks like impaired coronary perfusion is essential for effective hypertension management.

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