Blood Pressure Target
High Time That We Finally Agreed What Is Healthy
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See related article, pp 1110–1114
Over the past 60 years, we learnt not only to appreciate the risk associated with elevated blood pressure (BP), but also to implement efficient therapeutic modalities capable of markedly reducing the risk of cardiovascular complications. However, such seemingly simple matter as deciding the exact therapeutic goals to which BP should be lowered to reduce the risk of events is probably as far from being universally agreed on as it must have been in the fifties.
The recent versions of major guideline documents1,2 indicate that for low- to moderate-risk adults <60 years of age, BP should be lowered to <140 mm Hg systolic and <90 mm Hg diastolic. This also applies to patients with coronary artery disease, diabetes mellitus, and chronic kidney disease (Table).1,2 The goal for diastolic blood pressure is <90 mm Hg (<85 mm Hg in diabetes mellitus).2
However, essential hypertension is to a large extent a disease affecting older adults. It was shown that in this particular group of male patients, the risk of death associated with level of blood pressure raises at ≈160 mm Hg,6 and as further elegantly indicated by Zanchetti et al,7 until recently, there have been no data from randomized clinical trials to indicate that lowering of systolic BP (SBP) to <140 mm Hg could lead to benefit in this subgroup of hypertensive patients.7 The elderly are heterogeneous group, where the ability to cope impacts heavily on survival. Recently, Benetos et al proposed that in the elderly frail patients, the therapeutic goal should revolve about the value …