title: Facts and fallacies of blood pressure control in recent trials: implications in the management of patients with hypertension.
abstract: 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.
authors.affiliation: Centro di Fisiologia Clinica e Ipertensione, University of Milan, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanchetti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Henry R
authors.initials: HR
authors.lastname: Black
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Bernard
authors.initials: B
authors.lastname: Waeber
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Franz H
authors.initials: FH
authors.lastname: Messerli
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents