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June 16, 2011American Journal of Hypertension

Redefining Blood Pressure Targets in High-Risk Patients?: Lessons From Coronary Endpoints in Recent Randomized Clinical Trials

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Why the study?

Does intensive antihypertensive therapy (target systolic BP < 120 mm Hg) reduce major cardiovascular events compared to standard therapy in high-risk patients?

Population

High-risk patients with hypertension, diabetes, or chronic renal disease

Comparison

Intensive antihypertensive therapy aimed at… vs Standard antihypertensive therapy

Design

Review

Authors

MVMassimo VolpeGTGiuliano Tocci

Discussion

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Member takes

Overview

May warrant caution with systolic BP targets <120 mm Hg in high-risk patients; leaves optimal targets unresolved pending dedicated trials.

Structured PICO

Does intensive antihypertensive therapy (target systolic BP < 120 mm Hg) reduce major cardiovascular events compared to standard therapy in high-risk patients?

P
Population
High-risk patients with hypertension, diabetes, or chronic renal disease
I
Intervention
Intensive antihypertensive therapy aimed at achieving target systolic BP < 120 mm Hg
C
Comparator
Standard antihypertensive therapy
O
Outcome
Major cardiovascular events, coronary events (mostly myocardial infarction), and strokehard clinical

Aggressive blood pressure lowering below 120 mm Hg in high-risk patients may increase the risk of coronary events, suggesting caution and revitalizing the J-curve concept.

Cite This Study

Volpe et al. (2011) studied this question.

synapsesocial.com/papers/6a83d6e0f72f0ca72062ceabhttps://doi.org/10.1038/ajh.2011.105
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Facts and fallacies of blood pressure control in recent trials: implications in the management of patients with hypertension2009 · 63 citations
  2. 2Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus2010 · 3,635 citations
  3. 3The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure&lt;SUBTITLE&gt;The JNC 7 Report&lt;/SUBTITLE&gt;2003 · 25,562 citations
  4. 4J-curve revisited: an analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial2010 · 368 citations
  5. 5Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study2000 · 2,158 citations