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 ) .
Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial
BACKGROUND In chronic nephropathies , inhibition of angiotensin-converting enzyme ( ACE ) is renoprotective , but can further renoprotection be achieved by reduction of blood pressure to lower than usual targets ? We aim ed to assess the effect of intensified versus conventional blood-pressure control on progression to end-stage renal disease . METHODS We undertook a multicentre , r and omised controlled trial of patients with non-diabetic proteinuric nephropathies receiving background treatment with the ACE inhibitor ramipril ( 2.5 - 5 mg/day ) . We r and omly assigned participants either conventional ( diastolic < 90 mm Hg ; n=169 ) or intensified ( systolic/diastolic < 130/80 mm Hg ; n=169 ) blood-pressure control . To achieve the intensified blood-pressure level , patients received add-on therapy with the dihydropyridine calcium-channel blocker felodipine ( 5 - 10 mg/day ) . The primary outcome measure was time to end-stage renal disease over 36 months ' follow-up , and analysis was by intention to treat . FINDINGS Of 338 patients who were r and omised , three ( two assigned intensified and one allocated conventional blood-pressure control ) never took study drugs and they were excluded . Over a median follow-up of 19 months ( IQR 12 - 35 ) , 38/167 ( 23 % ) patients assigned to intensified blood-pressure control and 34/168 ( 20 % ) allocated conventional control progressed to end-stage renal disease ( hazard ratio 1.00 [ 95 % CI 0.61 - 1.64 ] ; p=0.99 ) . INTERPRETATION In patients with non-diabetic proteinuric nephropathies receiving background ACE-inhibitor therapy , no additional benefit from further blood-pressure reduction by felodipine could be shown
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 ) .