title: Blood pressure targets recommended by guidelines and incidence of cardiovascular and renal events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET).
abstract: BACKGROUND
  Hypertension treatment guidelines recommend that blood pressure (BP) be lowered to <140/90 mm Hg, but that a reduction to <130/80 mm Hg be adopted in patients at high cardiovascular (CV) risk. We investigated the CV and renal benefits associated with these BP targets in the high-CV-risk population of the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET).
  
  
  RESULTS
  Patients were divided into 4 groups according to the proportion of in-treatment visits before the occurrence of an event (<25%->75%) in which BP was reduced to <140/90 or <130/80 mm Hg. After adjustment for demographic and clinical variables, a progressive increase in the proportion of visits in which BP was reduced to <140/90 or <130/80 mm Hg was associated with a progressive reduction in the risk of stroke, new onset of microalbuminuria or macroalbuminuria, and return to normoalbuminuria in albuminuric patients. An increased frequency of BP control to either target did not have any consistent effect on the adjusted risk of myocardial infarction and heart failure. The adjusted risk of CV events was reduced by increasing the frequency of BP control to <140/90 mm Hg, but not to <130/80 mm Hg. Similar findings were obtained for the achievement of the BP target in the visit preceding a CV event.
  
  
  CONCLUSIONS
  The more frequent achievement of the BP targets recommended by guidelines led to cerebrovascular and renal protection, but did not increase cardiac protection. Overall, CV protection was favorably affected by the less tight but not by the tighter BP target. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00153101.
authors.affiliation: Clinica Medica, University of Milano-Bicocca, Ospedale San Gerardo, Monza, Italy. giuseppe.mancia@unimib.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Helmut
authors.initials: H
authors.lastname: Schumacher
authors.forename: Josep
authors.initials: J
authors.lastname: Redon
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.forename: Roland
authors.initials: R
authors.lastname: Schmieder
authors.forename: Garry
authors.initials: G
authors.lastname: Jennings
authors.forename: Khalid
authors.initials: K
authors.lastname: Yusoff
authors.forename: Lars
authors.initials: L
authors.lastname: Ryden
authors.forename: G Lisheng
authors.initials: GL
authors.lastname: Liu
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.forename: Peter
authors.initials: P
authors.lastname: Sleight
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000517:prevention & control; D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D001565:Benzoates / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D017408:Guidelines as Topic / Q000592:standards*; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D017257:Ramipril / Q000494:pharmacology / Q000627:therapeutic use*; D012306:Risk; D020521:Stroke / Q000517:prevention & control; D000077333:Telmisartan
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001565:Benzoates; D017257:Ramipril; D000077333:Telmisartan