When are we going to tackle arterial hypotension?

Introduction Blood pressure is a physiological component of circulatory system, with increased cardiovascular risk in cases of elevation (hypertension) or decrease (hypotension). Limits for hypertension are well-established in all guidelines and recommendations, unlike limits for hypotension. Hypotension can lead to poor perfusion of vital organs, especially coronary flow subjected to low diastolic pressures, with serious consequences1. This issue concerns specially in Primary Care, with possible iatrogenic hypotension induced by inadequate or excessive anti-hypertensive drugs, due to flawed diagnoses or follow-up2. Purpose As there are no guidelines for hypotension, the objective of this study is to evaluate whether and how this condition is addressed in various hypertension guidelines. Method Literature review of diagnostic classifications of lower limits of normality (office) and blood pressures below these limits, in various guidelines Results [Figure 1] Discussion The J-curve for diastolic blood pressure reduction has been observed in several studies, with nadirs of 60 mmHg (SPRINT/ACCORD), 72 mmHg (ONTARGET), and 84 mmHg (INVEST)10 indicating increased cardiovascular risk in patients with various clinical conditions. Only the ESC classification allows for this possibility, but without categorizing any risk below 120/70 mmHg. Categories such as "normal" or "optimal" embody the dangerous notion of "the lower, the better" and need to be revised in future guidelines. Minimum acceptable pressures must be established, if possible.