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Evaluating Mean Blood Pressure as a Potential Therapeutic Target in Systolic Hypertension with Too Low Baseline
Goran Koraćević1,2, Milovan Stojanović2,3
1Department of Cardiology, University Clinical Centre Niš, Niš, Serbia.
Insights
Isolated systolic hypertension (ISH) with low diastolic blood pressure (dBP) is a difficult clinical problem. This review suggests mean blood pressure (BP) as a potential treatment target for ISH patients with low dBP.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Medicine
Background:
- Isolated systolic hypertension (ISH) is linked to high mortality and hypertension-mediated organ damage (HMODs).
- A subset of ISH patients presents with a low pre-treatment diastolic blood pressure (dBP), posing treatment challenges.
Purpose of the Study:
- To investigate if current hypertension (HTN) guidelines propose mean blood pressure (BP) as a treatment target for ISH patients with low dBP.
- To analyze the rationale for considering mean BP as a potential antihypertensive treatment target.
Main Methods:
- A comprehensive literature search was conducted across major databases including Scopus, Medline, Springer Nature, Cambridge University Press, Oxford University Press, Wiley-Blackwell, and Google Scholar.
- The search focused on identifying hypertension guidelines and their recommendations regarding treatment targets for ISH.
Main Results:
- Mean BP is utilized for treatment guidance in specific settings like intensive care units and is acknowledged in guidelines for evaluating antihypertensive treatment.
- However, mean BP is absent as a chronic treatment target in half of the reviewed HTN guidelines, and notably, none mention it for ISH patients with low baseline dBP.
Conclusions:
- The clinical challenge of treating ISH with low baseline dBP is recognized but currently lacks a defined therapeutic strategy.
- This study proposes mean BP as a subject for further investigation and evaluation to optimize antihypertensive treatment intensity in ISH patients with low dBP.
Introduction:
Isolated systolic hypertension (ISH) has a high mortality rate and a high prevalence of hypertension-mediated organ damage (HMODs). The aims of this paper are: (1) to search arterial hypertension (HTN) guidelines to determine whether mean blood pressure (BP) is mentioned as a treatment target for ISH patients with too-low pre-treatment dBP, and (2) to analyze whether there is a rationale for suggesting mean BP as a potential antihypertensive treatment target.
Methods:
We performed a search for HTN guidelines in Scopus, the Medline database, Springer Nature, Cambridge University Press, Oxford University Press, and Wiley-Blackwell. The scholarly search engine Google Scholar was also used.
Results:
Mean BP is already used to guide BP treatment in numerous settings, mostly in intensive care units, and guidelines recognize that mean BP can be used in several clinical scenarios to evaluate antihypertensive treatment. However, mean BP is not mentioned in half of the guidelines, and none of the 40 HTN guidelines mention mean BP as a chronic treatment target in ISH.
Discussion:
The main finding of this narrative review is that the problem of ISH with a too-low baseline dBP has been clearly identified but remains unresolved. This paper does not offer a definitive answer but presents an initial approach to addressing the problem.
Conclusion:
The problem of ISH with too-low dBP is clinically relevant, and such patients are difficult to treat. We propose mean BP for investigation and evaluation as a means of adjusting the intensity of antihypertensive treatment in large patient populations with ISH and too-low dBP.
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