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How low should blood pressure be in patients with chronic coronary and cerebrovascular diseases

A J Manolis1, M S Kallistratos1, M Camafort2

  • 1Cardiology Department, Metropolitan Hospital, Piraeus, Greece.

European Journal of Internal Medicine
|January 11, 2023
PubMed

Insights

Lowering blood pressure too aggressively may harm patients. Recent studies show benefits of intensive treatment, but data isn't applicable to all, especially those with coronary or cerebrovascular diseases.

Area of Science:

  • Cardiology
  • Neurology
  • Hypertension Management

Background:

  • Intensive blood pressure (BP) lowering has shown reduced cardiovascular (CV) events and mortality in recent trials.
  • However, current evidence is not universally applicable to the general hypertensive population.
  • Conflicting guideline recommendations exist for BP thresholds, particularly for patients with coronary artery disease (CAD) and stroke.

Purpose of the Study:

  • To review evidence and controversies surrounding intensive BP lowering.
  • To define optimal BP thresholds for patients with chronic coronary or cerebrovascular diseases.
  • To identify patient phenotypes vulnerable to over-aggressive BP reduction.

Main Methods:

  • Systematic review of recent trials and meta-analyses on intensive BP lowering.
  • Analysis of guideline recommendations since 2017.
  • Examination of BP thresholds in specific patient populations (CAD, stroke).

Main Results:

  • Intensive BP lowering is associated with reduced CV events and mortality.
  • Data applicability to the general hypertensive population is limited.
  • Varied BP targets are recommended across guidelines for specific conditions.

Conclusions:

  • Defining limits for intensive BP lowering is crucial.
  • Identifying vulnerable patient phenotypes is necessary to avoid harm.
  • Further research is needed to establish precise BP targets for chronic cardiovascular and cerebrovascular diseases.

Keywords:
Blood pressure targetsCerebrovascular diseaseCoronary artery diseaseHypertension

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