Evidence for a lower target blood pressure for people with heart disease.
OBJECTIVE
The review assesses the evidence for the benefit of lower blood pressure (BP) targets in hypertension management.


RESULTS
The current consensus target for the treatment of hypertension is a BP of below 140/90 mmHg for all patients, and a BP of below 130/80 mmHg for those with diabetes or chronic kidney disease. Recently added to the list of conditions warranting the lower BP target are coronary artery disease and coronary artery disease equivalents (stroke, carotid disease, aortic aneurysm, and peripheral vascular disease), as well as those individuals with a Framingham Risk Score of at least 10%. One theoretical issue with lower BP targets may be the existence of a J-shaped curve of BP versus cardiovascular event rate, implying a greater risk, especially of myocardial ischemia, of lowering diastolic BP, which is also the filling pressure of the coronary arteries, below the lower limit of coronary autoregulation. The evidence that this is not a compelling concern is provided by animal studies, clinical trials with both surrogate and hard endpoints, and epidemiologic data.


CONCLUSIONS
There is at present no proof that more aggressive treatment is harmful and much indirect evidence that it may be beneficial, although the clinical trials that specifically address this question are still in progress.
Rosendorff
Clive
C
Mount Sinai School of Medicine, New York, New York, USA. clive.rosendorff@va.gov
Black
Henry R
HR
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D003324:Coronary Artery Disease / Q000517:prevention & control; D003971:Diastole / Q000187:drug effects; D019317:Evidence-Based Medicine; D006331:Heart Diseases / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000517:prevention & control*; D018570:Risk Assessment
D000959:Antihypertensive Agents