Mixed Messages on Blood Pressure Goals

Abstract

See related article, pp 1061–1068 The management of hypertension has represented one of the most important therapeutic successes of the past 50 to 60 years. The capability now exists to lower blood pressure (BP) effectively and with relatively minimal adverse effects in most hypertensive individuals. The debate regarding therapy has shifted from whether lowering BP is beneficial to such issues as the relative benefits and risks of individual antihypertensive medications, their long-term effects on cardiovascular disease (CVD) and chronic renal disease outcomes, and the optimal BP goals of therapy in different clinical conditions. Based on extensive clinical trial data, general agreement has existed that lowering elevated BP to <140 mm Hg systolic and 90 mm Hg diastolic BP is beneficial. Lower BP goals have been suggested on the basis of epidemiological and observational data indicating that CVD risk increases progressively from BP levels as low as 115/75 mm Hg.1 The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommended a goal BP of ≤130/80 mm Hg in hypertensive patients with chronic renal disease or diabetes mellitus,2 consistent with the recommendations of the National Kidney Foundation and the American Diabetes Association. Subsequently, the American Heart Association expanded this list by recommending BP targets <130/80 mm Hg for patients with preexisting coronary heart diseases, angina pectoris, and acute coronary syndromes or those at high risk for CVD, and BP <120/80 mm Hg for those with left ventricular dysfunction.3 Generally similar recommendations have been made by other national or international groups as well. However, the available evidence may not justify such an aggressive approach. For example, the African American Study of Kidney Disease and Hypertension compared the effects of goal BP of ≤140/90 …