Korean J Intern Med.  2019 Jan;34(1):44-49. 10.3904/kjim.2018.382.

Management plans for populations with normal-to-hypertensive blood pressures: risks and benefits of antihypertensive drug treatment in populations previously defined as having high-normal blood pressure

• Park S

• KMID: 2452485
• DOI: http://doi.org/10.3904/kjim.2018.382

Abstract

Recent changes in American and European guidelines on the management of arterial hypertension have caused a considerable shift in the landscape of hypertension management. The 2017 American College of Cardiology/American Heart Association/American Society of Hypertension guideline recommends an office visit blood pressure (BP) > 130/80 mmHg as the new threshold for diagnosis of hypertension, and states that the treatment goal for all hypertensive patients should be lowered to < 130/80 mmHg. In contrast, the 2018 European guideline maintains the diagnostic threshold of hypertension at 140/90 mmHg. However, despite their differences in thresholds for diagnosis of hypertension, both guidelines are in agreement that treatment should be considered in patients with BPs in the range of 130 to 139/80 to 89 mmHg if they have high cardiovascular risk. The results from the Systolic Blood Pressure Intervention Trial (SPRINT) study and recent meta-analyses suggest that BP lowering with antihypertensive treatment may be beneficial in reducing cardiovascular event rates in subjects with high-normal BP or stage 1 hypertension according to the new American guideline. However, intensive BP lowering is associated with increased incidence of treatment-associated adverse events, and evidence suggests that BP lowering below 120/70 mmHg increases the risk of cardiovascular events. In this review, we discuss the evidence supporting antihypertensive treatment in subjects with high-normal BP and discuss the specific subgroup of subjects that might benefit from BP lowering.

Keyword

Blood pressure; Hypertension; Treatment target; Cardiovascular diseases

MeSH Terms

Blood Pressure*
Cardiovascular Diseases
Diagnosis
Heart
Humans
Hypertension
Incidence
Office Visits
Risk Assessment*