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[Target blood pressure values in hypertension treatment; how low is optimal?]

Wilko Spiering1, Diederick E Grobbee

  • 1Universitair Medisch Centrum Utrecht, Utrecht.

Nederlands Tijdschrift Voor Geneeskunde
|November 21, 2013
PubMed

Insights

Optimal blood pressure varies per patient, influencing cardiovascular health. Guidelines suggest targets like <140/90 mmHg, but individual needs, especially for the elderly and those with diabetes, require careful consideration for effective blood pressure management.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Geriatric Medicine

Background:

  • A J-curve relationship exists between blood pressure levels and cardiovascular morbidity/mortality.
  • Optimal blood pressure is not uniform across all patient populations.
  • Current hypertension guidelines provide general target values based on clinical studies.

Purpose of the Study:

  • To explore the nuances of optimal blood pressure targets.
  • To review guideline-recommended blood pressure targets for various patient groups.
  • To discuss considerations for blood pressure management in specific populations, including the elderly and those with comorbidities.

Main Methods:

  • Review of existing randomized interventional studies comparing different blood pressure targets.
  • Analysis of current clinical guidelines for hypertension management.
  • Synthesis of evidence regarding blood pressure targets in patients with cardiovascular disease, chronic kidney disease, diabetes mellitus, and the elderly.

Main Results:

  • General target blood pressure is <140/90 mmHg for patients with cardiovascular disease or chronic kidney disease.
  • For patients with diabetes mellitus, the target blood pressure is <140/85 mmHg.
  • For hypertensive patients over 80 years, target systolic blood pressure (SBP) is 140-150 mmHg and diastolic blood pressure (DBP) is 70-80 mmHg, requiring cautious management.

Conclusions:

  • Optimal blood pressure targets vary individually and may differ for preventing stroke versus myocardial infarction in patients with coronary heart disease or diabetes.
  • Blood pressure lowering in the fragile elderly necessitates careful titration.
  • Guideline targets serve as a general framework, but personalized approaches are crucial for effective cardiovascular risk reduction.

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