Hypertension Guidelines: Effect of Blood Pressure Targets

There has been an abundance of hypertension guidelines over the years. Their purpose is to convey evidence-based findings from clinical trials to clinicians so that best medical choices can be made for the diagnosis and treatment of patients with hypertension. Over the past 3 years new hypertension guidelines have been published in the United States, Canada, Europe, and elsewhere with new or refined recommendations made regarding diagnosis, therapy, and intensity of treatment. Previous national guidelines were generally well aligned. However, there are major differences in the current North American and European recommendations in terms of the classification of hypertension and treatment goals, with the diagnosis of hypertension starting at 140/90 mm Hg for the European guidelines and 130/80 mm Hg for the American and Canadian guidelines. An important controversial aspect in the updated guidelines relates to a lowered threshold (130/80 mm Hg) at which hypertension is diagnosed and treated, because growing evidence indicates that individuals at low cardiovascular risk might be exposed to incremental harm because of overtreatment with antihypertensive drugs. However, these concerns need to be weighed against the robust evidence from the landmark Systolic Blood Pressure Intervention Trial (SPRINT) study and numerous meta-analyses, which clearly showed that intensive blood pressure-lowering aimed at a systolic blood pressure of 120-130 mm Hg causes ̴a significant, > 25% reduction in cardiovascular morbidity and mortality. This review highlights some of the important discrepancies between the major current guidelines, with a focus on definitions and treatment goals of hypertension. The effect of lower blood pressure targets and intensive antihypertensive treatment on cardiovascular benefit and risk is also discussed.