Treating patients to lower than st and ard BP targets , < /=140 - 160/90 - 100 mmHg , does not reduce mortality or morbidity .
BACKGROUND When treating elevated blood pressure , doctors need to know what blood pressure ( BP ) target they should try to achieve .
The st and ard of clinical practice for some time has been < /= 140 - 160/ 90 - 100 mmHg .
New guidelines are recommending BP targets lower than this st and ard .
It is not known whether attempting to achieve targets lower than the st and ard reduces mortality and morbidity .
OBJECTIVES To determine if lower BP targets ( < /= 135/85 mmHg ) are associated with reduction in mortality and morbidity as compared with st and ard BP targets ( < /= 140 - 160/ 90 - 100 mmHg ) .
Benefits and risks of more intensive blood pressure lowering in hypertensive patients of the HOT study with different risk profiles: does a J-shaped curve exist in smokers?
Background The Hypertension Optimal Treatment ( HOT ) Study investigated 18 790 hypertensives r and omized to three diastolic blood pressure ( DBP ) targets ( ⩽ 90 , ⩽ 85 , ⩽ 80 mmHg ) for 3.8 years and found marked , significant reductions in cardiovascular events and mortality the lower the target DBP in the subset of diabetics . We investigated whether the benefits of intensive DBP lowering could be extended to other subgroups , and whether there are hypertensives in whom the risk of aggressive DBP lowering may outnumber the benefits . Methods and results The 18 790 patients were stratified as : medium/high – very high global cardiovascular risk ; men/women ; older/younger ; current smokers/non-smokers ; higher/lower serum cholesterol ; higher/lower serum creatinine ; with/without diabetes ; with/without ischaemic heart disease ( IHD ) . Comparisons were made between the less aggressive target group ( DBP < 90 mmHg ) and the two more aggressive target groups together ( ⩽ 85 and ⩽ 80 mmHg ) . A Cox proportional hazards model was used to calculate treatment – subgroup interactions and relative risks ( RR ) with 95 % confidence intervals . Benefits were greatest in diabetics ( RR 0.53 for cardiovascular events , and 0.67 for cardiovascular death ) , whereas in smokers more intensive DBP lowering was associated with increased risk of all types of cardiovascular event ( RR 1.71–2.67 ; P = 0.01–0.001 ) , except myocardial infa rct ion . After excluding smokers , intensive  DBP lowering was associated with significant reductions in cardiovascular events in diabetics ( −49 % ) , high – very high risk patients ( −23 % ) , IHD patients ( −32 % ) , patients with lower creatinine ( −18 % ) , women ( −33 % ) and older patients ( −23 % ) . Conclusions Although subanalyses have only a descriptive value , it appears reasonable to recommend intensive antihypertensive treatment to hypertensives with diabetes , IHD and high global cardiovascular risk . In smokers , treatment intensification should be associated with the greatest efforts to induce smoking cessation
Treating patients to lower than st and ard BP targets , < /=140 - 160/90 - 100 mmHg , does not reduce mortality or morbidity .
BACKGROUND When treating elevated blood pressure , doctors need to know what blood pressure ( BP ) target they should try to achieve .
The st and ard of clinical practice for some time has been < /= 140 - 160/ 90 - 100 mmHg .
New guidelines are recommending BP targets lower than this st and ard .
It is not known whether attempting to achieve targets lower than the st and ard reduces mortality and morbidity .
OBJECTIVES To determine if lower BP targets ( < /= 135/85 mmHg ) are associated with reduction in mortality and morbidity as compared with st and ard BP targets ( < /= 140 - 160/ 90 - 100 mmHg ) .