What question did this study set out to answer?

The study aims to evaluate how arterial hypotension is addressed in current hypertension guidelines.

June 12, 2026European Journal of Preventive Cardiology0 citationsOpen Access

When are we going to tackle arterial hypotension?

Q: What is the clinical evidence from this study?

Study design: Review. Population: Arterial hypotension. Primary outcome: Diagnostic classifications of lower limits of normality and blood pressures below these limits in various guidelines.

JTJ ThalenbergNational Institute of Science and Technology for Software Engineering

Key Result

A literature review of hypertension guidelines found that only the ESC classification acknowledges the risk of low blood pressure, but no guidelines categorize risk below 120/70 mmHg.

Key Points

The study aims to evaluate how arterial hypotension is addressed in current hypertension guidelines.
Conducted a literature review of diagnostic classifications for low blood pressure.
Analyzed various hypertension guidelines for guidelines on hypotension.
Examined the implications of current standards on cardiovascular risk.
Observed the J-curve for diastolic blood pressure indicating increased cardiovascular risk at lower pressures.
Only the ESC classification recognizes the risk of low diastolic pressures (below 120/70 mmHg).
Current guidelines may propagate dangerous ideologies, necessitating minimum acceptable pressure standards.

Structured PICO

How is arterial hypotension addressed in current hypertension guidelines?

Population

Various hypertension guidelines

Intervention

Literature review of diagnostic classifications of lower limits of normality (office) and blood pressures below these limits

Outcome

Evaluation of whether and how arterial hypotension is addressed in various hypertension guidelines

Current hypertension guidelines fail to adequately define or categorize the risks of arterial hypotension, suggesting a need to establish minimum acceptable blood pressure limits.

Abstract

Abstract 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.For image description, please refer to the figure legend and surrounding text.

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