Lower blood pressure targets: to whom do they apply?

@article{Brunstrm2016LowerBP,
  title={Lower blood pressure targets: to whom do they apply?},
  author={Mattias Brunstr{\"o}m and Bo Carlberg},
  journal={The Lancet},
  year={2016},
  volume={387},
  pages={405-406}
}

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.

TLDR
The evidence was very uncertain about withdrawals due to adverse effects in the treatment of people with hypertension and the need to titrate antihypertensives to reach a specific blood pressure goal, and there was probably little to no difference in total mortality or cardiovascular mortality.

Systolic blood pressure trajectory and cardiovascular outcomes: An analysis using data in the Systolic Blood Pressure Intervention Trial

TLDR
This work aimed to investigate the relationship between systolic blood pressure trajectory and cardiovascular outcomes using data from the Systolic Blood Pressure Intervention Trial (SPRINT).

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.

TLDR
No evidence of a difference in total mortality, serious adverse events, or total cardiovascular events between people with hypertension and cardiovascular disease treated to a lower or to a standard blood pressure target is found, suggesting that no net health benefit is derived from a lower systolic blood Pressure target.

Achieving target SBP for lowering the risk of major adverse cardiovascular events in persons with diabetes mellitus

TLDR
Achieving a standard SBP goal between 120 and 140 mmHg may prove useful for lowering cardiovascular risk in persons with diabetes mellitus, and achieving a target SBP less than 120 does not appear to mitigate risk.

Predicting Risk of Type 2 Diabetes by Using Data on Easy-to-Measure Risk Factors

TLDR
A key risk factor for type 2 diabetes was increasing age, especially for those older than 69, followed by a family history of diabetes, with diminished risk among individuals younger than 45.

PREVENTING CHRONIC DISEASE

  • 2017

Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels – updated overview and meta-analyses of randomized trials

TLDR
Updating of previous meta-analyses indicates that more vs. less intense BP lowering can reduce not only stroke and coronary events, but also cardiovascular mortality.

Update in Hypertension Therapy.

References

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Blood Pressure, Systolic and Diastolic, and Cardiovascular Risks: US Population Data

TLDR
The present review summarizes recent data from US prospective population studies on blood pressure—systolic (SBP), diastolic (DBP)—and cardiovascular risk and relationships to the outcome variables.

Effects of blood pressure lowering on outcome incidence in hypertension: 2. Effects at different baseline and achieved blood pressure levels – overview and meta-analyses of randomized trials

TLDR
Meta-analyses favor BP-lowering treatment even in grade 1 hypertension at low-to-moderate risk, and lowering SBP/DBP to less than 140/90 mmHg appears safe, but only adds further reduction in stroke.

Blood pressure, systolic and diastolic, and cardiovascular risks. US population data.

TLDR
Recent data from US prospective population studies on blood pressure--systolic (SBP), diastolic (DBP)--and cardiovascular risk is summarized and a great potential exists for improved health and increased longevity through control of the blood pressure problem.

2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

TLDR
A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People and the Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction is presented.

Effects of intensive blood-pressure control in type 2 diabetes mellitus.

TLDR
In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm HG, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events.

2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

TLDR
Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.