Am J Hypertens. 2022 Apr 7:hpac045. doi: 10.1093/ajh/hpac045. Online ahead of print.
ABSTRACT
Epidemiologic studies have consistently identified a strong, progressive relationship between blood pressure and cardiovascular disease events, in a range of systolic blood pressure (SBP) from as low as 90 mm Hg to as high as 180 mm Hg. Clinical trials have demonstrated greater prevention of cardiovascular disease with more compared to less intensive antihypertensive drug treatment. Meta-analyses of randomized controlled trials provides strong evidence for more intensive antihypertensive drug therapy down to an SBP of 130 mm Hg, and to an SBP 120-124 mm Hg in the meta-analysis with the greatest statistical power. In the Systolic Blood Pressure Intervention Trial (SPRINT) randomization to an SBP treatment goal of <120 mm Hg compared to <140 mm Hg in persons with high cardiovascular disease risk not only reduced the rate of cardiovascular disease but also all-cause mortality. These benefits were noted in all of the pre-stated subgroups of interest, including those ≥65 years of age at baseline. In addition, cognitive impairment was less common in those randomized to the intensive compared to standard treatment. Most clinical practice guidelines recommend an SBP treatment target <130 mm Hg in adults with a high risk of CVD, which is the norm for many patients seen in clinical practice, especially those who are older, have diabetes mellitus, or chronic kidney disease.
PMID:35390116 | DOI:10.1093/ajh/hpac045
