Does aggressive blood pressure reduction to <130/80 mmHg improve cardiovascular outcomes compared to a <140/90 mmHg target in high-risk hypertensive patients?
Aggressive blood pressure reduction to <130/80 mmHg in high-risk hypertensive patients may not offer substantial advantages over a <140/90 mmHg target, except potentially for stroke reduction.
In the high CV risk, hypertensives of the VALUE trial reducing BP consistently to <140/90 mmHg had marked beneficial effects both when data were calculated as proportion of visits at BP target or as on-treatment mean BP. Reducing BP to <130/80 mmHg led only to some possible further benefit on stroke, whereas the risk of other outcomes remained substantially similar to or slightly greater than that seen at the higher target. Thus, aggressive BP reductions when CV risk is high may not offer substantial advantages, except perhaps in patients or conditions in which stroke risk is particularly common.
Mancia et al. (Fri,) studied this question.