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High Blood Press Cardiovasc Prev. 2018 Jun;25(2):151-158. doi: 10.1007/s40292-018-0258-z. Epub 2018 Apr 16.

Which Target Blood Pressure in Year 2018? Evidence from Recent Clinical Trials.

Author information

1
Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway.
2
Department of Emergency Medicine, Ullevaal University Hospital, Oslo, Norway.
3
Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland.
4
Department of Clinical Sciences, Skåne University Hospital, Malmö, Sweden.
5
Department of Cardiology, Ullevaal University Hospital, Oslo, Norway. sverrkj@online.no.
6
Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. sverrkj@online.no.

Abstract

The Systolic Blood Pressure Intervention Trial (SPRINT) suggested a favourable effect of lowering blood pressure to < 120/80 mmHg in high-risk hypertensive patients; however, new American guidelines in 2017 have not followed SPRINT but lowered its recommended treatment target to < 130/80 mmHg. We aimed to review the latest research from large randomised controlled trials and observational analyses in order to investigate the evidence for new treatment targets. We assessed recent data from the Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD) study, the International Verapamil-Trandolapril Study (INVEST), the Telmisartan, Ramipril or Both in Patients at High Risk for Vascular Events trial (ONTARGET)/the Telmisartan Randomised AssessmenNt Study in aCE iNtolerant participants with cardiovascular Disease (TRANSCEND) study and The Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) study. These studies confirm a positive effect on cardiovascular protection with blood pressure lowering treatment to between 120-140 mmHg in patients with and without diabetes, but no additional effect of lowering blood pressure to < 120 mmHg; possibly too aggressive treatment may increase both cardiovascular morbidity and mortality. Thus, a target blood pressure < 130/80 mmHg appears appropriate in most high-risk hypertensive patients. Additionally, early and sustained BP control below this target is required for optimal cardiovascular protection.

KEYWORDS:

Antihypertensive drug-treatment; Antihypertensive therapy; Blood pressure measurement; Blood pressure target; Cardiovascular disease; Hypertension; Randomized controlled trial

PMID:
29663195
DOI:
10.1007/s40292-018-0258-z
[Indexed for MEDLINE]

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