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

Abstract

Background Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood pressure below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown. Objectives To determine if 'lower' blood pressure targets (≤ 135/85 mmHg) are associated with reduction in mortality and morbidity as compared with 'standard' blood pressure targets (≤ 140 to 160/ 90 to 100 mmHg) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). Search methods The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to February 2017: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the Latin American and Caribbean Health Science Literature Database (from 1982) and contacted authors of relevant papers regarding further published and unpublished work. There were no language restrictions. Selection criteria We included randomized controlled trials (RCTs) with more than 50 participants per group and at least six months follow-up. Trial reports needed to present data for at least one primary outcome (total mortality, serious adverse events, total cardiovascular events, cardiovascular mortality). Eligible interventions were lower target for systolic/diastolic blood pressure (≤ 135/85 mmHg) compared with standard target for blood pressure (≤ 140 to 160/90 to 100 mmHg). Participants were adults with documented hypertension or who were receiving treatment for hypertension and cardiovascular history for myocardial infarction, stroke, chronic peripheral vascular occlusive disease or angina pectoris. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease (Review)

Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2018

“…En las recomendaciones del PAPPS de 2016 51 se discuten los fundamentos de objetivos terapéuticos en situaciones concretas de riesgo (ancianos, diabetes mellitus tipo 2, enfermedad coronaria, ERC). Recientemente se han publicado varios metaanálisis o revisiones de estudios en ancianos 73 , con insuficiencia renal 74 , diabéticos 75 y de alto riesgo vascular 76 , sin encontrar diferencias significativas de mortalidad entre descensos más intensivos de PA (< 140 mmHg) frente al objetivo terapéutico de 140 mmHg. Aunque existen otras revisiones en diabetes 77,78 o insuficiencia renal 79 , que encontrarían beneficios para niveles de PA de 120-140 mmHg, en consonancia con el estudio SPRINT 64 , en esta edición seguimos manteniendo el objetivo de 140/90 mmHg, salvo en situaciones muy particulares, como la presencia de proteinuria o la consideración individualizada en situaciones de alto riesgo recién comentada.…”

Individual awareness and treatment effectiveness of hypertension among older adults in Ghana: evidence from the World Health Organization study of global ageing and adult health wave 2

“…Majority of strokes occur in undiagnosed hypertensives. Approximately 40% of all cardiovascular accidents occur in previously undiagnosed hypertensives [ 25 ]. This high prevalence of undiagnosed hypertensives raises a serious and potential public health crisis that requires urgent attention.…”

“…A significant proportion of elderly with hypertension in communities remains undiagnosed, untreated or inadequately treated in sub Saharan Africa [ 17 , 24 ]. Approximately 40% of all cardiovascular accidents occur in previously undiagnosed hypertensives [ 25 ]. Socio-demographic factors such as lower educational level, age and sex have been found to be associated with untreated hypertension and older age was significantly associated with uncontrolled hypertension [ 26 ].…”

Gender-specific Predictive Ability for the Risk of Hypertension Incidence Related to Baseline Level or Trajectories of Adiposity Indices: Cohort Study of Functional Community in Beijing Urban from 2015 to 2019 year

“…The identi cation of MS was in terms of the third guide of American Cholesterol Education Adult Therapy Panel (37) Metabolism-related indicators including: (1) Elevated blood pressure (BP ≥ 130/85 mmHg), (2) Elevated TG (TG ≥ 150 mg/dl or 1.7 mmol/L), (3) Elevated FPG (FPG ≥ 100 mg/dl or 5.6 mmol/L), (4) Reduced HDL-C (HDL-C < 40 mg/dL or 1.0 mmol/L in males, < 50 mg/dL or 1.3 mmol/L in females), (5) WC: ≥ 90 cm in males, ≥ 80 cm in females. Considering blood pressures were outcome in this study and the collinearity between WC and BMI, WHtR, we used TG, FPG and HDL-C to estimate Metabolic Status in this study.…”

“…Hypertension is one of the leading causes of premature death worldwide that signi cantly increases the risk of stroke, heart attract, kidney and blindness (1)(2)(3). According to the statistics of World Health Organization (WHO), 1.13 billion people were diagnosed as hypertension but less than 1 in 5 has it under control.…”