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Controversies in blood pressure goal guidelines and masked hypertension

Robert A Phillips1

  • 1University of Massachusetts Medical School, Worcester, Massachusetts.

Annals of the New York Academy of Sciences
|May 3, 2012
PubMed

Insights

Treatment goals for hypertension vary by age and risk factors, with lower targets for specific populations like African Americans and those with comorbidities. Masked hypertension, a condition of normal clinic blood pressure with elevated out-of-office readings, requires attention and monitoring.

Area of Science:

  • Cardiology
  • Nephrology
  • Internal Medicine

Background:

  • Current hypertension guidelines establish varying blood pressure (BP) treatment goals based on age and specific patient populations.
  • First-line therapies for uncomplicated hypertension include renin-angiotensin-aldosterone system inhibitors and calcium channel blockers, though thiazide diuretics and beta blockers remain subjects of debate.
  • African Americans exhibit higher target organ damage at similar BP levels compared to whites, necessitating adjusted treatment goals.

Purpose of the Study:

  • To outline current treatment goals for hypertension across different age groups and risk profiles.
  • To highlight the importance of considering specific populations, such as African Americans, and comorbidities like coronary artery disease, diabetes, and chronic kidney disease in hypertension management.
  • To emphasize the prevalence and adverse outcomes associated with masked hypertension and advocate for its inclusion in clinical guidelines.

Main Methods:

  • Review of existing hypertension guidelines and clinical recommendations.
  • Analysis of BP treatment targets for uncomplicated hypertension in individuals aged 18-79 and those 80 years and older.
  • Examination of specific BP goals for populations at higher risk, including African Americans and patients with comorbidities.
  • Definition and discussion of masked hypertension, its prevalence in specific patient groups (CKD, diabetes, OSA), and associated outcomes.

Main Results:

  • Treatment goal for uncomplicated hypertension is <140/90 mmHg for ages 18-79 and 140-150 mmHg for those 80+.
  • Lower BP goals (<135/85 mmHg) are recommended for African Americans due to higher risk of target organ damage.
  • Patients with coronary artery disease, diabetes, or chronic kidney disease should aim for <130/80 mmHg.
  • Masked hypertension, characterized by normal clinic BP but high out-of-office BP, is common in CKD, diabetes, and OSA and linked to poorer outcomes.

Conclusions:

  • Hypertension management requires individualized BP targets based on age, race, and comorbidities.
  • Masked hypertension is a significant clinical entity associated with adverse outcomes and warrants consideration in at-risk patients.
  • Ambulatory blood pressure monitoring should be integrated into guidelines for identifying and managing masked hypertension in susceptible individuals.

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