Establishing targets for hypertension control in patients with comorbidities.
Most current guidelines recommend tighter blood pressure (BP) control in hypertensive patients with comorbidities. These recommendations are based on epidemiologic data indicating that cardiovascular risk increases at lower BP levels in hypertensive patients with comorbidities than in those without comorbidities. Hypertension guidelines usually reflect outcomes from previous studies, but current recommendations for patients with comorbidities have preceded the evidence. We review recent studies investigating whether these new targets can be achieved, whether they are well tolerated, and whether they positively affect the outcomes. The results of the few current studies about outcomes in lower BP target groups are either negative or somewhat--but not decidedly--positive. There is a need for new trials designed to evaluate the validity of current recommendations for tighter BP control in hypertensive patients with comorbidities. Additionally, existing data from published trials could be reanalyzed to provide further clarification.
Feldstein
Carlos
C
Hypertension Program, Hospital de Clinicas J. de San Martin, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
Julius
Stevo
S
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D007674:Kidney Diseases / Q000453:epidemiology*; D008019:Life Style; D008875:Middle Aged; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome