Target goal blood pressure in hypertension management

Hae-Young Lee

doi:10.5124/jkma.2017.60.10.819

Journal List > J Korean Med Assoc > v.60(10) > 1043239

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee: Target goal blood pressure in hypertension management

Original Article

J Korean Med Assoc 2017;60(10):819-825.

Published online: 17 October 2017

DOI: https://doi.org/10.5124/jkma.2017.60.10.819

Target goal blood pressure in hypertension management

Hae-Young Lee, MD

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

Corresponding author: Hae-Young Lee E-mail: hylee612@snu.ac.kr

Received 10 September 2017 Accepted 24 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

As recently as about 50 years ago, hypertension was considered a natural protective mechanism that should not be treated. However, after the completion of the first Multicenter Veterans Administration Cooperative Study proving the benefits of blood pressure-lowering treatment for cardiovascular protection, there has been no more debate regarding the importance of controlling hypertension. Nevertheless, the most appropriate target blood pressure goal has been continuously debated. The recently published Systolic Blood Pressure Intervention Trial has again shifted the balance of consensus towards strict blood pressure control. Herein, I provide a brief summary history of the establishment of target blood pressure goals and current perspectives.

Keywords: Hypertension, Blood pressure, Cardiovascular risk

REFERENCES

1. Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet. 2014; 383:999–1008.

2. Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA. 1967; 202:1028–1034.

3. Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA. 1970; 213:1143–1152.

4. Five-year findings of the hypertension detection and followup program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group. JAMA. 1979; 242:2562–2571.

5. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991; 265:3255–3264.

6. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumi-trascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, Banya W, Bulpitt CJ. HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008; 358:1887–1898.

7. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling S. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998; 351:1755–1762.

8. ACCORD Study Group. Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, Cutler JA, Simons-Morton DG, Basile JN, Corson MA, Probstfield JL, Katz L, Peterson KA, Friedewald WT, Buse JB, Bigger JT, Gerstein HC, Ismail-Beigi F. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362:1575–1585.

9. SPRINT Research Group. Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC Jr, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373:2103–2116.

10. Lonn EM, Bosch J, Lopez-Jaramillo P, Zhu J, Liu L, Pais P, Diaz R, Xavier D, Sliwa K, Dans A, Avezum A, Piegas LS, Keltai K, Keltai M, Chazova I, Peters RJ, Held C, Yusoff K, Lewis BS, Jansky P, Parkhomenko A, Khunti K, Toff WD, Reid CM, Varigos J, Leiter LA, Molina DI, McKelvie R, Pogue J, Wilkinson J, Jung H, Dagenais G, Yusuf S. HOPE-3 Investigators. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016; 374:2009–2020.

11. MRC trial of treatment of mild hypertension: principal results. Medical Research Council Working Party. Br Med J (Clin Res Ed). 1985; 291:97–104.

12. Staessen J, Bulpitt C, Clement D, De Leeuw P, Fagard R, Fletcher A, Forette F, Leonetti G, Nissinen A, OʼMalley K. Relation between mortality and treated blood pressure in elderly patients with hypertension: report of the European Working Party on high blood pressure in the elderly. BMJ. 1989; 298:1552–1556.

13. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998; 317:703–713.

14. Wright JT Jr, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek D, Douglas-Baltimore JG, Gassman J, Glassock R, Hebert L, Jamerson K, Lewis J, Phillips RA, Toto RD, Middleton JP, Rostand SG. African American Study of Kidney Disease and Hypertension Study Group. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002; 288:2421–2431.

15. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, Fine LJ, Haley WE, Hawfield AT, Ix JH, Kitzman DW, Kostis JB, Krousel-Wood MA, Launer LJ, Oparil S, Rodriguez CJ, Roumie CL, Shorr RI, Sink KM, Wadley VG, Whelton PK, Whittle J, Woolard NF, Wright JT Jr, Pajewski NM. SPRINT Research Group. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA. 2016; 315:2673–2682.

16. Gerin W, Marion RM, Friedman R, James GD, Bovbjerg DH, Pickering TG. How should we measure blood pressure in the doctorʼs office? Blood Press Monit. 2001; 6:257–262.

17. Myers MG, Campbell NR. Unfounded concerns about the use of automated office blood pressure measurement in SPRINT. J Am Soc Hypertens. 2016; 10:903–905.

18. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017; 136:e137–e161.

19. Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, Woodward M, MacMahon S, Turnbull F, Hillis GS, Chalmers J, Mant J, Salam A, Rahimi K, Perkovic V, Rodgers A. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and metaanalysis. Lancet. 2016; 387:435–443.

20. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and metaanalysis. Lancet. 2016; 387:957–967.

21. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension. 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels: updated overview and metaanalyses of randomized trials. J Hypertens. 2016; 34:613–622.

22. Juurlink DN, Mamdani MM, Lee DS, Kopp A, Austin PC, Laupacis A, Redelmeier DA. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. 2004; 351:543–551.

23. American Diabetes Association. 9. Cardiovascular disease and risk management. Diabetes Care. 2017; 40(Suppl 1):S75–S87.

24. Perkovic V, Rodgers A. Redefining blood-pressure targets: SPRINT starts the marathon. N Engl J Med. 2015; 373:2175–2178.

25. Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and metaanalysis. JAMA. 2015; 313:603–615.

26. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension. 2. Effects at different baseline and achieved blood pressure levels: overview and metaanalyses of randomized trials. J Hypertens. 2014; 32:2296–2304.

27. Weber MA, Julius S, Kjeldsen SE, Brunner HR, Ekman S, Hansson L, Hua T, Laragh JH, McInnes GT, Mitchell L, Plat F, Schork MA, Smith B, Zanchetti A. Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE Trial. Lancet. 2004; 363:2049–2051.

28. Liu L, Zhang Y, Liu G, Li W, Zhang X, Zanchetti A. FEVER Study Group. The Felodipine Event Reduction (FEVER) Study: a randomized longterm placebo-controlled trial in Chinese hypertensive patients. J Hypertens. 2005; 23:2157–2172.

Table 1.

Major clinical trials regarding blood pressure target goal

Study	Year	Major issue	Answer
VA-1st [2]	1967	Does severe hypertension (DBP 115-129 mmHg) need to be treated?	Yes, less stroke and heart failure incidence
VA-2nd [3]	1970	Does moderate hypertension (DBP 90-115 mmHg) need to be treated?	Yes, less stroke and heart failure incidence
HDFP [4]	1970	Is target goal-guided BP therapy better than usual therapy?	Yes. Targeting DBP goal <90 mmHg reduced CVA by >36%
MRC [11]	1985	Hypertension control in younger patients (35-64) is beneficial?	Yes, less cardiovascular events
EWHPE [12]	1986	Hypertension control in younger patients (>60) is beneficial?	Yes, 26% mortality and 43% cardiovascular mortality reduction
SHEP [5]	1991	Is treatment of systolic hypertension (SBP ≥ 160 mmHg) beneficial?	Yes, less cardiovascular events
HOT [7]	1998	Is lowering DBP to <85 or <80 mmHg beneficial compared to standard 90 mmHg goal?	No significant benefit in overall study population but small benefit in diabetic patients
UKPDS [13]	1998	Is intensive BP control under 150/80 mmHg better than usual therapy in diabetic patients?	Yes, less death, stroke, and retinopathy
AASK [14]	2002	Is intensive mean BP control under 92 mmHg better than usual therapy under 105 mmHg in chronic kidney disease patients?	No, but long term observation cohort showed benefit in albuminuria (+) patients
HYVET [6]	2008	Should we treat elderly (>80) hypertensive (SBP >160 mmHg)?	Yes, 30% less stroke, 64% less heart failure, and 21% less death
ACCORD [8]	2010	Is goal SBP <120 mmHg better than 140 mmHg in diabetic patient?	No significant difference in mortality, total cardiovascular events, or renal protection
SPRINT [9]	2015	Is goal SBP <120 mmHg better than 140 mmHg in non-diabetic high risk hypertensive population? (BP measured by ambulatory office BP measurement)	Yes, 27% less mortality and 25% less cardiovascular events
HOPE [10]	2016	Is further BP reduction in moderate cardiovascular risk hypertensive patients with SBP around 140 mmHg beneficial?	No significant difference in mortality or total cardiovascular events
HOPE [10]	2016	Is further BP reduction in moderate cardiovascular risk hypertensive patients with SBP around 140 mmHg beneficial?	No significant difference in mortality or total cardiovascular events

VA, Multicenter Veterans Administration Cooperative Study; DBP, diastolic blood pressure; HDFP, Hypertension Detection and Follow-Up; CVA, cerebrovascular accident; MRC, Medical Research Council; EWHPE, European Working Party High Blood pressure in the Elderly; SHEP, Systolic Hypertension in Elderly Program; SBP, systolic blood pressure; HOT, Hypertension Optimal Treatment; UKPDS, United Kingdom Prospective Diabetes Study; BP, blood pressure; AASK, African American Study of Kidney DiseaseHYVET, Hypertension in the Very Elderly Trial; ACCORD, Action to Control Cardiovascular Risk in Diabetes; SPRINT, Systolic Blood Pressure Intervention Trial; HOPE, Heart Outcomes Prevention Evaluation.

TOOLS

Similar articles