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Blood pressure targets in cardiovascular risk patients - evidence or common sense

Hypertension


The joint session of the European Society of Hypertension and European Society of Cardiology focused on a controversial issue of blood pressure goals of treatment. The validity of the goal of <130/80 mmHg previously recommended for high cardiovascular risk patients was questioned by all speakers due to the lack of evidence of clinical benefits.

Giuseppe Mancia pointed out that analyses of recent trials raise the possibility that low achieved blood pressure values are associated with increased rather than decreased risk of coronary outcomes.

Antonio Coca stressed that the previous recommendation to aim at a lower goal SBP (<130mmHg) in post-stroke patients is not supported by trial evidence, as in no randomized trial has SBP been brought down to below 130mmHg with proven benefits.

Similar conclusions might be drawn from the studies in patients with type 2 diabetes which were reviewed by Peter Nilsson. He reminded that in the ACCORD BP study, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of cardiovascular events in patients with type 2 diabetes.

Faiez Zannad stressed that BP management in heart failure patients, because of lack of specific clinical trials, is based solely on common sense.

The main message from the session is that it may be prudent to recommend lowering SBP/DBP to values within the range 130–139/80–85mmHg, and possibly close to lower values in this range, in all hypertensive patients with preserved LV systolic function. Direct evidence in support of lowering systolic BP below 130 mmHg in high risk patients, including those with history of stroke, is urgently needed.

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Blood pressure targets in cardiovascular risk patients - evidence or common sense

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.