[Limits to the treatment of hypertension]

Area of Science:

• Cardiology
• Hypertension Management
• Evidence-Based Medicine

Background:

• The 2011 Dutch guideline recommends a systolic blood pressure (SBP) target of <140 mmHg for hypertensive patients without cardiovascular disease or diabetes.
• The recent American guideline advocates for a stricter SBP target of <130 mmHg for all adult patients.
• This shift is driven by randomized studies and meta-analyses evaluating intensive antihypertensive therapy's impact on mortality and cardiovascular disease risk.

Purpose of the Study:

• To evaluate the evidence supporting intensive antihypertensive therapy (targeting SBP <130 mmHg) in various patient populations.
• To compare the recommendations of the Dutch and American guidelines regarding SBP targets for hypertension management.

Main Methods:

• Review of randomized studies and meta-analyses on intensive antihypertensive therapy.
• Analysis of literature regarding the efficacy of SBP <130 mmHg target in different patient groups.

Main Results:

• Intensive antihypertensive therapy (SBP <130 mmHg) shows sufficient evidence of benefit in patients with existing cardiovascular disease.
• Intensive therapy is also supported for patients identified as having high cardiovascular risk.
• Current evidence is insufficient to support intensive antihypertensive therapy for patients with diabetes mellitus or those over 80 years old.

Conclusions:

• Intensive antihypertensive therapy with an SBP target of <130 mmHg is strongly supported for patients with cardiovascular disease and high cardiovascular risk.
• Further research is needed to establish the benefits of intensive SBP lowering in patients with diabetes mellitus and the elderly (over 80 years).
• Guidelines differ on SBP targets, highlighting ongoing evolution in hypertension management strategies.