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 ) .
Hypertension in Diabetes Study IV. Therapeutic requirements to maintain tight blood pressure control
Hypertension in Diabetes Study Group*
Summary We report the efficacy of therapy over 5 years follow-up in 758 non-insulin-dependent diabetic patients in a prospect i ve , r and omised controlled study of therapy of mild hypertension . Patients were recruited who on antihypertensive therapy had systolic blood pressure over 150 mmHg or diastolic over 85 mmHg , or if not on therapy had systolic blood pressure over 160 mmHg or diastolic over 90 mmHg . Their mean blood pressure at entry to the study was 160/94 mmHg at a mean age of 57 years . They were allocated to tight control ( aim ing for systolic < 150/diastolic < 85 mmHg ) or to less tight control ( aim ing for systolic < 180/ diastolic < 105 mmHg ) . The tight control group were allocated to primary therapy either with a beta blocker ( atenolol ) or with an antiotensin converting enzyme inhibitor ( captopril ) , with addition of other agents as required . Over 5 years , the mean blood pressure in the tight control group was significantly lower ( 143/82 vs 154/88 mmHg , p < 0.001 ) . No difference was seen between those allocated to atenolol or captopril . The proportion of patients requiring three or more antihypertensive therapies to maintain tight control in those allocated to atenolol or captopril increased from 16 and 15 % , respectively at 2 years to 25 and 26 % , respectively at 5 years , whereas in the less tight control group at 2 and 5 years only 5 and 7 % , respectively required three or more therapies . There was no difference in the incidence of side effects or hypoglycaemic episodes between those allocated to atenolol or captopril , but those allocated to atenolol increased their body weight by a mean of 2.3 kg compared with 0.5 kg in those allocated to captopril ( p < 0.01 ) . Allocation to atenolol was also associated with small increases in triglyceride , and decreases in LDL and HDL cholesterol , which are of uncertain clinical relevance . The study is continuing to determine whether the improved blood pressure control , which was obtained , will be beneficial in maintaining the health of patients by decreasing the incidence of major clinical complications , principally myocardial infa rct ion and strokes , and microvascular complications , such as severe retinopathy requiring photocoagulation and deterioration of renal function . [ Diabetologia ( 1996 ) 39 : 1554–1561
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 ) .