Abstract
Expert committees in the United States and Europe formulated their currently recommended target blood pressures of <140/90 mm Hg or <130/80 mm Hg in persons with diabetes, chronic kidney disease, or coronary artery disease based on the totality of clinical data available at the time. However, accumulating evidence indicates that increased risk for cardiovascular and renal complications of hypertension may begin at a threshold of 115/75 mm Hg, suggesting that benefit from treatment may occur when blood pressure targets are lower than those currently recommended. Combination therapy with two or more agents having complementary mechanisms of action is the most effective method for achieving strict blood pressure goals in high-risk patients. Several clinical trials are under way to further determine the risks and benefits of lowering blood pressure beyond the currently recommended threshold.
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