[Blood pressure: the lower the better? Maybe no]

Area of Science:

• Cardiology
• Nephrology
• Geriatrics

Context:

• International guidelines and clinical trials present varying perspectives on blood pressure targets for antihypertensive therapy.
• The optimal intensity of drug treatment for hypertension is debated, with uncertainty regarding the risks and benefits of lower blood pressure values.
• The Systolic Blood Pressure Intervention Trial (SPRINT) investigated intensive versus standard blood pressure management in non-diabetic hypertensive individuals.

Purpose:

• To review evidence on blood pressure targets in hypertensive patients with comorbidities, including chronic kidney disease and cardiovascular disease.
• To evaluate the applicability of the 'lower is better' approach in geriatric hypertensive patients, considering factors like frailty and polypharmacy.

Summary:

• The SPRINT trial indicated benefits of intensive antihypertensive treatment in reducing morbidity and mortality, but these findings were not consistent across all patient subsets.
• Analysis of studies involving hypertensive patients with comorbidities revealed no strong evidence supporting intensive treatment targets.
• The 'lower is better' paradigm for blood pressure management is not fully applicable to geriatric patients due to complex health factors.

Impact:

• Current evidence does not provide a definitive consensus on optimal blood pressure targets for all hypertensive populations.
• Further research is needed to clarify the benefits and risks of intensive antihypertensive strategies in diverse patient groups, particularly those with comorbidities and the elderly.