Examining therapeutic goals: population versus individual-based approaches.
In the individual patient, the goal of antihypertensive treatment is to lower the blood pressure (BP) to a level that minimizes the patient's risk of cardiovascular complications. However, most of our knowledge regarding what this level of BP should be is derived from population studies and large clinical trials. Population studies have shown that elevated BP is associated with an increased risk of morbidity and mortality from coronary heart disease, stroke, heart failure, and renal failure. Cardiovascular risk begins to increase when BP exceeds 115/75 mm Hg and doubles with each increment of 20 mm Hg in systolic BP and 10 mm Hg in diastolic BP.The clinical benefit of BP reduction in patients with hypertension is well established. Thus, patients with less severe elevations in BP (high-normal) are at increased risk. Patients with diabetes or proteinuria benefit from even more aggressive reductions in BP. Despite the well-established benefits of BP reduction, hypertension is still not well treated, underscoring the need for more aggressive detection and better management. Although data from large clinical trials have provided valuable information to help guide treatment, application of clinical trial results to individual patients is limited by the heterogeneity of patient populations with respect to patient risk, comorbidities, and differences in genetic and environmental background. Ultimately, the treatment decisions should be tailored to each patient, integrating as much information as possible concerning the patient's history, risk, pathophysiology, and lifestyle.
Giles
Thomas D
TD
Department of Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana 70112, USA. tgiles@lsuhsc.edu
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents