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Which Target Blood Pressure in Year 2018? Evidence from Recent Clinical Trials

Sondre Heimark1, Julian E Mariampillai2, Krzysztof Narkiewicz3

  • 1Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway.

High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension
|April 18, 2018
PubMed

Insights

Lowering blood pressure to below 130/80 mmHg benefits high-risk hypertensive patients. Aggressively lowering systolic blood pressure below 120 mmHg may increase risks, making 130/80 mmHg an appropriate target.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Clinical Research

Background:

  • The Systolic Blood Pressure Intervention Trial (SPRINT) indicated benefits of blood pressure < 120/80 mmHg in high-risk patients.
  • American guidelines in 2017 recommended a less stringent target of < 130/80 mmHg, diverging from SPRINT findings.

Purpose of the Study:

  • To review recent large randomized controlled trials and observational studies.
  • To investigate the evidence supporting new treatment targets for hypertension.

Main Methods:

  • Analysis of data from major trials including ACCORD, INVEST, ONTARGET/TRANSCEND, and LIFE.
  • Review of randomized controlled trials and observational analyses.

Main Results:

  • Blood pressure lowering treatment between 120-140 mmHg shows cardiovascular protection in patients with and without diabetes.
  • No additional benefit observed when lowering blood pressure below 120 mmHg.
  • Overly aggressive blood pressure reduction may increase cardiovascular morbidity and mortality.

Conclusions:

  • A target blood pressure of < 130/80 mmHg is appropriate for most high-risk hypertensive patients.
  • Early and sustained blood pressure control below this target is crucial for optimal cardiovascular protection.

Keywords:
Antihypertensive drug-treatmentAntihypertensive therapyBlood pressure measurementBlood pressure targetCardiovascular diseaseHypertensionRandomized controlled trial

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