Facts and fallacies of blood pressure control in recent trials: implications in the management of patients with hypertension.
A large body of clinical trial data indicates that a given difference in blood pressure (BP), as measured in the clinic, results in a given difference in outcome. This correlation underpins current US and European guidelines for the management of hypertension. However, findings from recent comparative trials may appear inconsistent with a fixed relationship between BP lowering and outcome benefit, at least at all BP ranges, at all levels of total cardiovascular risk and with all drug combinations. We review the findings of six of these recent trials and conclude that their complex design precludes a simple interpretation, that several important questions remain unanswered and that direct evidence - particularly in support of lowering systolic BP below 140 or 130 mmHg - is urgently needed.
Zanchetti
Alberto
A
Centro di Fisiologia Clinica e Ipertensione, University of Milan, Milan, Italy.
Mancia
Giuseppe
G
Black
Henry R
HR
Oparil
Suzanne
S
Waeber
Bernard
B
Schmieder
Roland E
RE
Bakris
George L
GL
Messerli
Franz H
FH
Kjeldsen
Sverre E
SE
Ruilope
Luis M
LM
D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002986:Clinical Trials as Topic; D003920:Diabetes Mellitus / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D020521:Stroke / Q000517:prevention & control; D014652:Vascular Diseases / Q000503:physiopathology
D000959:Antihypertensive Agents