Korean Circ J.  2019 Nov;49(11):1002-1009. 10.4070/kcj.2019.0261.

Ideal Target Blood Pressure in Hypertension

Affiliations
  • 1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. shpark0530@yuhs.ac

Abstract

In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive blood pressure (BP) lowering was associated with significant reduction in composite cardiovascular (CV) outcomes in hypertension. Subsequently, several meta-analyses have corroborated the findings from SPRINT and these benefits were more prominent in subjects with higher cardiovascular risk at baseline. As such, the recent American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline and the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guideline recommended the lowering of target BP to less than 130/80 mmHg in most hypertensive subjects. However, one should keep in mind the potential harm of too much BP lowering. Post hoc analysis of clinical trials have demonstrated increased cardiovascular mortality and events with too much BP lowering. Therefore, although intensive BP lowering may be beneficial in further reducing CV outcomes, too much reduction below 120/70 mmHg may actually harmful. In conclusion, although intensive BP lowering to achieve target BP below 130/80 mmHg is beneficial in reducing CV outcomes, one should do so cautiously as to avoid adverse events. As such, the first target of anti-hypertensive treatment should be to achieve BP lowering below 140/90 mmHg. Once that target is achieved, one could target BP below 130/80 mmHg keeping in mind to avoid signs of organ hypoperfusion such as orthostatic hypotension, orthostatic dizziness, weakness and serum creatinine elevation.

Keyword

Hypertension; Blood pressure; Cardiovascular diseases

MeSH Terms

Blood Pressure*
Cardiology
Cardiovascular Diseases
Creatinine
Dizziness
Heart
Hypertension*
Hypotension, Orthostatic
Mortality
Creatinine

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Reference

1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018; 71:e127–e248.
2. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39:3021–3104.
3. Kim KI, Ihm SH, Kim GH, et al. 2018 Korean society of hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin Hypertens. 2019; 25:19.
Article
4. Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA. 1967; 202:1028–1034.
5. Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA. 1970; 213:1143–1152.
6. Hypertension-Stroke Cooperative Study Group. Effect of antihypertensive treatment on stroke recurrence. JAMA. 1974; 229:409–418.
7. Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA. 1979; 242:2562–2571.
8. The Australian therapeutic trial in mild hypertension. Report by the Management Committee. Lancet. 1980; 315:1261–1267.
9. Medical Research Council Working Party. MRC trial of treatment of mild hypertension: principal results. Br Med J (Clin Res Ed). 1985; 291:97–104.
10. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet. 1998; 351:1755–1762.
Article
11. Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med. 1994; 330:877–884.
Article
12. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289:2560–2572.
13. ACCORD Study Group. Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362:1575–1585.
Article
14. Wright JT Jr, Bakris G, Greene T, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002; 288:2421–2431.
15. Ruggenenti P, Perna A, Loriga G, et al. Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial. Lancet. 2005; 365:939–946.
Article
16. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31:1281–1357.
17. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311:507–520.
18. SPRINT Research Group. Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373:2103–2116.
Article
19. Pappaccogli M, Di Monaco S, Perlo E, et al. Comparison of automated office blood pressure with office and out-off-office measurement techniques. Hypertension. 2019; 73:481–490.
Article
20. Roerecke M, Kaczorowski J, Myers MG, et al. Comparing automated office blood pressure readings with other methods of blood pressure measurement for identifying patients with possible hypertension: a systematic review and meta-analysis. JAMA Intern Med. 2019; 179:351–362.
21. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016; 387:957–967.
Article
22. Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016; 387:435–443.
Article
23. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels - updated overview and meta-analyses of randomized trials. J Hypertens. 2016; 34:613–622.
24. Lee CJ, Ryu J, Kim HC, et al. Clinical benefit of treatment of stage-1, low-risk hypertension. Hypertension. 2018; 72:1285–1293.
Article
25. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991; 265:3255–3264.
26. Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet. 1997; 350:757–764.
Article
27. Wang JG, Staessen JA, Gong L, Liu L. Systolic Hypertension in China (Syst-China) Collaborative Group. Chinese trial on isolated systolic hypertension in the elderly. Arch Intern Med. 2000; 160:211–220.
Article
28. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008; 358:1887–1898.
Article
29. JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res. 2008; 31:2115–2127.
30. Ogihara T, Saruta T, Rakugi H, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study. Hypertension. 2010; 56:196–202.
31. Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA. 2016; 315:2673–2682.
32. Messerli FH, Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006; 144:884–893.
Article
33. Böhm M, Schumacher H, Teo KK, et al. Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Lancet. 2017; 389:2226–2237.
Article
34. Kimm H, Mok Y, Lee SJ, Lee S, Back JH, Jee SH. The J-curve between diastolic blood pressure and risk of all-cause and cardiovascular death. Korean Circ J. 2018; 48:36–47.
Article
35. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering treatment in hypertension: 8. Outcome reductions vs. discontinuations because of adverse drug events - meta-analyses of randomized trials. J Hypertens. 2016; 34:1451–1463.
36. Bansilal S, Castellano JM, Garrido E, et al. Assessing the impact of medication adherence on long-term cardiovascular outcomes. J Am Coll Cardiol. 2016; 68:789–801.
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