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Hypertensive goals in patients with coronary artery disease

Ryan T Cunnane1, George L Bakris

  • 1ASH Comprehensive Hypertension Center, The University of Chicago Medicine, IL 60637, USA.

Current Cardiology Reports
|August 15, 2012
PubMed

Insights

Lowering blood pressure below 140/90 mm Hg reduces cardiovascular risk, but further reduction below 130/80 mm Hg shows minimal benefit. New guidelines support a target of <140/90 mm Hg.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Hypertension Research

Background:

  • Numerous clinical trials have investigated cardiovascular outcomes over the past 20 years.
  • Recent trials (last 5 years) demonstrate significant cardiovascular risk reduction with blood pressure below 140/90 mm Hg.

Purpose of the Study:

  • To analyze current evidence on optimal blood pressure targets for cardiovascular risk reduction.
  • To evaluate the impact of improved standard of care on antihypertensive drug efficacy in recent trials.

Main Methods:

  • Review of prospective clinical trials examining cardiovascular outcomes.
  • Analysis of data from trials completed within the last 5 and 10 years.

Main Results:

  • Blood pressure lowering to <140/90 mm Hg reduces overall cardiovascular risk.
  • Driving blood pressure below 130/80 mm Hg does not yield greater risk reduction, with few exceptions like stroke prevention.
  • Recent trials show lower baseline cardiovascular risk due to improved standard of care, affecting observed drug efficacy.
  • Caution is advised against lowering diastolic blood pressure below 60 mm Hg, particularly in the elderly, to prevent reduced coronary perfusion.

Conclusions:

  • Current data support a blood pressure goal of <140/90 mm Hg.
  • The efficacy of antihypertensive drug classes may appear reduced in recent trials due to a higher standard of care at baseline.
  • Avoiding excessively low diastolic blood pressure is crucial for maintaining coronary perfusion, especially in elderly populations.

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