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The case for a greater blood pressure fall
1Department of Geriatrics, University of Uppsala, Sweden.
Insights
Treated hypertension patients face cardiovascular risks despite treatment. Lowering blood pressure too aggressively may also increase risks, a concept explored in the HOT Study.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Clinical Trials
Background:
- Intervention trials indicate treated hypertensive patients have elevated cardiovascular risks.
- Potential reasons include suboptimal blood pressure control or risks associated with aggressive blood pressure lowering (J-curve effect).
Purpose of the Study:
- To discuss findings from the Blood Pressure Lowering and Blood Pressure Control (BBB) Study and the ongoing Hypertensive Optimal Treatment (HOT) Study.
- To provide an update on the Hypertensive Optimal Treatment (HOT) Study's findings regarding blood pressure management in hypertension.
Main Methods:
- Review of findings from the published BBB Study.
- Analysis of ongoing data from the large-scale Hypertensive Optimal Treatment (HOT) Study.
- Focus on prospective intervention trial methodologies in hypertension management.
Main Results:
- Discussed findings from the BBB Study.
- Presented an update on the Hypertensive Optimal Treatment (HOT) Study, examining cardiovascular outcomes in relation to blood pressure targets.
- Explored the balance between achieving normotensive levels and the potential risks of overly aggressive blood pressure reduction.
Conclusions:
- Findings from the BBB and HOT studies inform the optimal blood pressure targets for hypertensive patients.
- Further insights from the HOT Study are crucial for refining hypertension treatment guidelines.
- The discussion emphasizes the ongoing investigation into managing cardiovascular risks in treated hypertensive individuals.
Abstract:
Several large intervention trials in hypertension have shown that treated hypertensive patients are at increased risk of cardiovascular morbidity and mortality in spite of being treated. One possible explanation for this is the fact that the treated blood pressure rarely if ever is brought down to strictly normotensive levels. Against this view is the J-curve argument that suggests that too vigorous lowering of blood pressure may increase cardiovascular risks. Two prospective intervention trials have addressed this problem, the BBB Study, which has been published, and the much larger HOT Study which is still ongoing. Some of the findings in these two trials will be discussed with an emphasis on giving an up-date of the HOT Study.