Key result
Targeting a systolic blood pressure <120 mmHg compared to <140 mmHg reduces cardiovascular complications but increases the risk of iatrogenic hypotension, supporting a personalized approach.
Why the study?
Defining the target level of blood pressure remains controversial, with conflicting findings between trials such as SPRINT and ACCORD regarding stricter targets.
Does stricter blood pressure control (target systolic BP <120 mmHg) reduce cardiovascular complications and deaths compared to standard control (<140 mmHg)?
Does stricter blood pressure control (target systolic BP <120 mmHg) reduce cardiovascular complications and deaths compared to standard control (<140 mmHg)?
A personalized approach to determining BP targets, utilizing central aortic pressure and vessel state assessment, is recommended due to conflicting results between major trials and increased risks of hypotension with strict targets.
Supports individualized BP targets amid hypotension risk; leaves open optimal thresholds for specific populations.
The review contains results of analysis of clinical studies on the problem of defining the target level of the blood pressure (BP). The rationale for selection the target systolic BP level below120 mmHg was obtained in the SPRINT study comparing the target levels <120 mmHg and <140 mmHg. A considerably lower number of cardiovascular complications and deaths was seen in the group of a stricter BP control. Nevertheless, this study had some limitations related to certain patient populations, and methods of BP measurement. More ambitious target of BP lowering was associated with elevated risk of iatrogenic hypotension and fainting. Moreover, the ACCORD study, exploring the same target levels failed to demonstrate similar risk reduction. Taking into account various literature data, the authors find it reasonable to use personalized approach to determining BP targets, and utilize assessment of central aortic pressure and state of vessels for more accurate risk stratification and selection of treatment.
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Антропова et al. (2019) conducted a review in Blood pressure control. Target systolic BP <120 mmHg vs. Target systolic BP <140 mmHg was evaluated. Targeting a systolic blood pressure <120 mmHg compared to <140 mmHg reduces cardiovascular complications but increases the risk of iatrogenic hypotension, supporting a personalized approach.
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