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 ) .
Effect of intensive blood pressure control on the course of type 1 diabetic nephropathy. Collaborative Study Group.
Diabetic nephropathy is the most common cause of end-stage renal disease in the United States . We undertook a study to assess the impact of assignment to different levels of blood pressure control on the course of type 1 diabetic nephropathy in patients receiving angiotensin-converting enzyme ( ACE ) inhibitor therapy .  We also examined the long-term course of this well-characterized cohort of patients receiving ACE inhibitor therapy . One hundred twenty-nine patients with type 1 diabetes and diabetic nephropathy who had previously participated in the Angiotensin-Converting Enzyme Inhibition in Diabetic Nephropathy Study who had a serum creatinine level less than 4.0 mg/dL were r and omly assigned to a mean arterial blood pressure ( MAP ) goal of 92 mm Hg or less ( group I ) or 100 to 107 mm Hg ( group II ) . Patients received varying doses of ramipril as the primary therapeutic antihypertensive agent . All patients were followed for a minimum of 2 years . Outcome measures included iothalamate clearance , 24-hour creatinine clearance , creatinine clearance estimated by the Cockcroft and Gault formula , and urinary protein excretion . The average difference in MAP between groups was 6 mm Hg over the 24-month follow-up . The median iothalamate clearance in group I was 62 mL/min/1.73 m(2 ) at baseline and 54 mL/min/1.73 m(2 ) at the end of the study compared with a baseline of 64 mL/min/1.73 m(2 ) and final 58 mL/min/1.73 m(2 ) in group II . There were no statistically significant differences in the rate of decline in renal function between groups . There was a significant difference in follow-up total urinary protein excretion between group I ( 535 mg/24 h ) and group II ( 1,723 mg/24 h ; P = 0.02 ) . Thirty-two percent of 126 patients achieved a final total protein excretion less than 500 mg/24 h. Patients from groups I and II had equivalent rates of adverse events . In patients with type 1 diabetes mellitus and diabetic nephropathy , the MAP goal should be 92 mm Hg or less for optimal renoprotection , if defined as including decreased proteinuria . With the combination of ACE inhibition and intensive blood pressure control , many patients can achieve regression or apparent remission of clinical evidence of diabetic nephropathy
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 ) .