Achieving blood pressure targets for prolonged cardiovascular health: a historical perspective

Hypertension is a major risk factor for coronary artery disease (CAD), stroke, heart failure, and chronic kidney disease (CKD), and its successful control leads to a decrease or prevention of these complications. Areas covered: Over the years the Joint National Committees and the American Heart Association have issued guidelines regarding the treatment of hypertension. Those of 2003 and 2007 respectively, have recommended reduction of blood pressure (BP) to < 140/90 mmHg for uncomplicated hypertension and to < 130/80 mmHg for hypertensive patients with diabetes mellitus, CKD, or CAD. Since stricter controls of BP, especially of the systolic BP (SBP) to < 120 mmHg did not provide additional cardiovascular (CV) benefits, except for stroke, the national committees in 2014 and 2015 issued new guidelines recommending more relaxed BP control based on recent studies. However, the recent publication of the Systolic Blood Pressure Intervention Trial (SPRINT) has challenged these guidelines by showing that aggressive SBP control to < 120 mmHg was associated with significant CV benefits. Expert commentary: Based on the results of SPRINT, the current guidelines will, most likely, be revised to recommend stricter BP control, possibly, close to 2003 and 2007 guidelines. Till new guidelines for the treatment of hypertension are issued, the current guidelines should be followed. However, the treatment can be individualized according to the patient status.