How Low Should We Treat Blood Pressure and Why?
With nearly 50 million Americans having high blood pressure, defined as a blood pressure of greater than or equal to 140/90 mm Hg, any therapeutic approach that improves the likelihood of success by either improved tolerability or better capability of keeping blood pressure controlled can have a profound impact on subsequent risk for cardiovascular disease. Therapeutic strategies thus far have not been entirely successful in controlling blood pressure, even to goals of less than 140/90 mm Hg in part due to the asymptomatic nature of the disease process. But maybe this goal should be lowered. Perhaps if target pressures are set at lower levels more people will be treated and outcome improved especially in high risk subjects. About one-half of Americans with high blood pressure are treated. Of those who are treated, only about 50% are controlled. These statistics may explain why treated hypertensives have not had the expected reduction in cardiovascular disease. Consequently, a careful reevaluation of target blood pressures and how to achieve this goal is of great interest. Many questions concerning whether to treat the systolic or diastolic pressures, how low to reduce them, and with which therapy remain unanswered. Specific antihypertensive medications may provide advantages not only with regard to their ability to control blood pressure but also through blood pressure independent mechanisms in preventing vascular and target organ damage. Clinical trials evaluating the benefits of lower target blood pressures with different types of medications are underway and may help provide insight with regard to future strategies to reduce cardiovascular risks in hypertensive patients. (c)1999 by Le Jacq Communications, Inc.
Weir
Matthew R.
MR
Division of Nephrology and Clinical Research Unit, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.