ABSTRACT
Although epidemiological data indicate that BP less than 115/75 mmHg is associated with the lowest risk of cardiovascular morbidity and mortality, several recent studies have concluded that excessive lowering of BP is not necessarily better for preventing cardiovascular events. Traditionally, the BP target has been less than 140/90 mmHg for all hypertensive patients. Recently, a lower target of less than 130/80 mmHg has been recommended for patients with diabetes mellitus, CKD, or established heart disease. However, these targets are controversial because the evidence base consists of subgroup analyses of clinical trials and/or extrapolations from other therapeutic areas (e.g. lipid-lowering therapy, for which a progressively lower target is beneficial for higher-risk patients). Relatively few outcome-based clinical trials have been carried out that randomized hypertensive subjects to different BP targets. A recent exception is the Action to Control Cardiovascular Risk in Diabetes – Blood Pressure (ACCORD-BP) Trial, which showed no significant benefit in hypertensive diabetics randomized to a systolic BP target of less than 120 mmHg. Because of the lack of direct clinical trial evidence, various guidelines offer different BP targets for different hypertensive subgroups, although most agree that higher-risk subjects ought to be treated to a lower than usually recommended BP, despite the lack of supporting evidence.
