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Lower blood pressure goals in high-risk cardiovascular patients: are they defensible?

Keith A Hopkins1, George L Bakris

  • 1The University of Chicago Pritzker School of Medicine, IL 60637, USA.

Cardiology Clinics
|July 13, 2010
PubMed

Insights

Lowering blood pressure (BP) below 130/80 mm Hg may prevent cardiovascular events and atherosclerosis progression. While data is limited, animal studies and clinical reasoning support aggressive BP management for high-risk individuals.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Hypertension Research

Background:

  • Current guidelines suggest varying blood pressure (BP) targets.
  • Evidence supporting a BP target below 130/80 mm Hg for all patients is limited.
  • High-risk cardiovascular (CV) individuals may benefit from lower BP levels.

Purpose of the Study:

  • To review the available data on actively decreasing blood pressure (BP) to less than 130/80 mm Hg.
  • To evaluate the impact of aggressive BP intervention on cardiovascular event rates and atherosclerosis.
  • To explore the rationale for preventing BP from exceeding specific thresholds.

Main Methods:

  • Literature review of studies investigating BP targets.
  • Analysis of data supporting lower BP levels in high-risk populations.
  • Consideration of animal experiments and clinical reasoning regarding BP management.

Main Results:

  • Paucity of data specifically supporting a universal BP target below 130/80 mm Hg.
  • Data suggests a lower cardiovascular (CV) event rate in high-risk individuals at this lower BP level.
  • Early, aggressive intervention may prevent worsening atherosclerosis.

Conclusions:

  • Most patients should aim for systolic BP well below 140 mm Hg, approaching 130 mm Hg.
  • While definitive proof is lacking, clinical common sense and animal studies support aggressive BP control.
  • Further research is needed to solidify the benefits of BP targets below 130/80 mm Hg.

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