Blood pressure targets in adults with hypertension

Arguedas, José Agustín; Leiva, Viriam; Wright, James M

doi:10.1002/14651858.cd004349.pub3

Cited by 24 publications

(23 citation statements)

References 128 publications

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“…It is a substantial factor for the development of atherosclerosis, with a high global incidence and prevalence that continues to increase and contributes to worldwide morbidity and mortality [1]. It constitutes a major risk factor for MetS-related cardiovascular disease and the leading cause of mortality related with MetS-associated chronic kidney failure, ischemic heart disease and stroke [2,3]. In 2015, a total of 1.13 billion adults had arterial hypertension worldwide [4]; this figure is predicted to increase to 1.56 billion by 2025 [5].…”

Section: Introductionmentioning

confidence: 99%

Impact of Helicobacter pylori-Related Metabolic Syndrome Parameters on Arterial Hypertension

et al. 2021

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Arterial hypertension is a risk factor for several pathologies, mainly including cardio-cerebrovascular diseases, which rank as leading causes of morbidity and mortality worldwide. Arterial hypertension also constitutes a fundamental component of the metabolic syndrome. Helicobacter pylori infection is one of the most common types of chronic infection globally and displays a plethora of both gastric and extragastric effects. Among other entities, Helicobacter pylori has been implicated in the pathogenesis of the metabolic syndrome. Within this review, we illustrate the current state-of-the-art evidence, which may link several components of the Helicobacter pylori-related metabolic syndrome, including non-alcoholic fatty liver disease and arterial hypertension. In particular, current knowledge of how Helicobacter pylori exerts its virulence through dietary, inflammatory and metabolic pathways will be discussed. Although there is still no causative link between these entities, the emerging evidence from both basic and clinical research supports the proposal that several components of the Helicobacter pylori infection-related metabolic syndrome present an important risk factor in the development of arterial hypertension. The triad of Helicobacter pylori infection, the metabolic syndrome, and hypertension represents a crucial worldwide health problem on a pandemic scale with high morbidity and mortality, like COVID-19, thereby requiring awareness and appropriate management on a global scale.

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Section: Introductionmentioning

confidence: 99%

Impact of Helicobacter pylori-Related Metabolic Syndrome Parameters on Arterial Hypertension

et al. 2021

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“…The results from our study are consistent with several prior reports [ 10 , 13 , 17 , 18 , 20 ], showing that high or low treatment BP levels are associated with an increased risk of cardiovascular outcomes and death. This J- or U-shaped relationship has been a matter of concern endorsed by many experts, and the optimal BP target for hypertensive patients with or without diabetes remains inconclusive [ 21 – 24 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical benefit of systolic blood pressure within the target range among patients with or without diabetes mellitus: a propensity score-matched analysis of two randomized clinical trials

Chen

Shi

et al. 2022

BMC Med

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Background Recent guidelines recommended a systolic blood pressure (SBP) target of < 130 mmHg for patients with or without diabetes but without providing a lower bound. Our study aimed to explore whether additional clinical benefits remain at achieved blood pressure (BP) levels below the recommended target. Methods We performed a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) among the non-diabetic population and the Action to Control Cardiovascular Risk in Diabetes BP (ACCORD-BP) trial among diabetic subjects. We used the propensity score method to match patients from the intensive BP group to those from the standard group in each trial. Individuals with different achieved BP levels from the intensive BP group were used as “reference.” For each stratum, the trial-specific primary outcome (i.e., composite outcome of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure (HF), or cardiovascular death for SPRINT; non-fatal MI, non-fatal stroke, or cardiovascular death for ACCORD-BP) was compared by Cox regression. Results A non-linear association was observed between the mean achieved BP and incidence of composite cardiovascular events, regardless of treatment allocation. The significant treatment benefit for primary outcome remained at SBP 110–120 mmHg (hazard ratio, 0.59 [95% CI, 0.46, 0.76] for SPRINT; 0.67 [0.52, 0.88] for ACCORD-BP) and SBP 120–130 mmHg for SPRINT (0.47 [0.34, 0.63]) but not for ACCORD-BP (0.93 [0.70, 1.23]). The results were similar for the secondary outcomes including all-cause mortality, cardiovascular mortality, MI, stroke, and HF. Intensive BP treatment benefits existed among patients maintaining a diastolic BP of 60–70 mmHg but were less distinct. Conclusions The treatment benefit persists at as low as SBP 110–120 mmHg irrespective of diabetes status. Achieved very low BP levels appeared to increase cardiovascular events and all-cause mortality.

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“…Sin embargo, un ensayo reciente en 8000 pacientes hipertensos chinos mayores (sin ictus previo), mostró la eficacia de una intervención intensa con objetivo de PAS 110-<130 mmHg frente a 130-<150 mmHg, aunque de nuevo hubo una mayor frecuencia de hipotensión en el grupo de intervención intensiva (25). Arguedas y cols realizaron un análisis de sensibilidad en una revisión sistemática, que incluyó solo ensayos con objetivo de PAS <130 mmHg frente a ensayos con objetivo <140 mmHg, y el único resultado significativo que obtuvieron fue un aumento de "otros eventos adversos graves" asociados con el objetivo inferior (26).…”

Section: Hipotensión En Hipertensos Mayores Tratadosunclassified

“…En otros términos, una PA tratada que en promedio es «sostenidamente baja» por el día o la noche en la vida cotidiana (medida con MAPA o AMPA) e «insegura» (curva J o U o síntomas). Más concretamente, y en ausencia de una definición consensuada de cifras de hipotensión ambulatoria, nuestro grupo ha propuesto partir de cifras de PA casual <110/70 mmHg en hipertensos tratados, derivadas de ensayos clínicos y estudios de cohorte (6,14,26,29,30) y utilizar sus equivalentes de PA ambulatoria por interpolaciones basadas en las guías norteamericanas de hipertensión y la literatura científica (6,14,29): <110/70 para la PA media diurna, <90/55 para la PA media nocturna y <105/65 mmHg para la media de 24 horas (29).…”

Section: Hipotensión En Hipertensos Mayores Tratadosunclassified

Hypotension in Older Treated Hypertensive Patients. Epidemiological Burden and Detection Efficiency

Banegas¹

2022

an. ranm

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Hypertension (systolic/diastolic blood pressure [SBP/DBP] ≥140 and/or ≥90 mmHg) is a very common condition in older people (prevalence >60%) and one of the leading causes of death and disability worldwide. The cardiovascular, cerebrovascular, and renal benefits of treating it properly are abundantly supported by clinical trials. However, an excessive reduction in BP (e.g., postural or pharmacological), especially if it is sustained over time, is less known but apparently more frequent than expected and clinically-efficient to detect (e.g., with ambulatory monitoring [ABPM] or home-BP self-measurement). Some studies have associated hypotension with a greater risk of fatigue, dizziness, imbalance, falls, cardiovascular disease, kidney damage, and dementia. In older and frail patients with treated hypertension, some proposed safety margins are SBP/DBP of 130-139 (if tolerated)/70-79 mmHg and, in general, BP should not be reduced below these values. Orthostatic hypotension (>20/10 mmHg fall in SBP/DBP within 3 minutes of erect standing) and ambulatory hypotension (mean daytime BP <110/70 mmHg) can be detected measuring standing BP in the office and with 24-hour ABPM, respectively. Several studies suggest that there may not be a single treatment goal for all patients because the BP/outcome relation seems to be modified by the patient’s age, co-morbidities, drugs, etc., and ignorance of this can lead to hypotension and other deleterious effects. The balance between efficacy and safety of the drug treatment of hypertension can be reasonably achieved by the good doctor practicing personalized medicine, individualizing the treatment of each of his older patients (who are genetic, demographic, physiological, metabolic, psychological, and culturally different), combining the updated scientific evidence, his/her experience and comprehensive knowledge of the patient (age, co-morbidities, etc), and the preferences of the patient or their caregiver. Most of this review is supported by some recent clinical practice guidelines.

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Blood pressure targets in adults with hypertension

Cited by 24 publications

References 128 publications

Impact of Helicobacter pylori-Related Metabolic Syndrome Parameters on Arterial Hypertension

Impact of Helicobacter pylori-Related Metabolic Syndrome Parameters on Arterial Hypertension

Clinical benefit of systolic blood pressure within the target range among patients with or without diabetes mellitus: a propensity score-matched analysis of two randomized clinical trials

Hypotension in Older Treated Hypertensive Patients. Epidemiological Burden and Detection Efficiency

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