Hypertension: empirical evidence and implications in 2014

Area of Science:

• Cardiology
• Evidence-Based Medicine
• Public Health

Background:

• High blood pressure (hypertension, HTN) is a major global cause of cardiovascular (CV) morbidity and mortality.
• Treatment of HTN has seen significant advancements over the past 50 years.
• Recent JNC-8 guidelines for blood pressure goals have sparked debate.

Purpose of the Study:

• To review and discuss the conflicting evidence regarding optimal blood pressure goals for hypertension.
• To evaluate the strengths and limitations of current hypertension treatment guidelines and research.
• To emphasize the importance of evidence-based medication and treatment strategies.

Main Methods:

• Review of existing literature, including the JNC-8 guidelines and a 2012 Cochrane meta-analysis.
• Analysis of conflicting findings from various hypertension studies.
• Discussion of methodological, statistical, and epistemological issues in hypertension research.

Main Results:

• The JNC-8 guidelines recommend a blood pressure goal of <140/90 mmHg for mild hypertension.
• A Cochrane meta-analysis found no evidence that treating mild hypertension reduces CV events or mortality and noted increased adverse events.
• Current evidence conflicts with JNC-8 recommendations, questioning the established treatment goals.

Conclusions:

• The evidence does not fully support the blood pressure goals set by the JNC-8 guidelines.
• The method of achieving blood pressure goals is more critical than the goal itself, especially considering medication side effects.
• There are significant conflicts and methodological issues in hypertension research that warrant careful consideration.