New blood pressure targets are low enough to be unachievable for most patients, say experts from Aberdeen University in this week's BMJ.
While plenty of strong evidence shows the benefits of lowering blood pressure, targets ? and their ceaseless revision ? are less evidence based, write Neil Campbell and Peter Murchie.
Even in clinical trials, most patients fail to achieve the newer, more stringent targets, while people older than 60 ? the bulk of patients with hypertension in general practice ? and people with diabetes are even less likely to reach this, they add.
Individual patients vary widely in their perception of acceptable risk and side effects when it comes to lowering their blood pressure yet, surprisingly, the patient's role in deciding his or her own blood pressure target receives scant attention in guidelines, they add. "If targets have a role, it is as something to be aimed for, not something that must be achieved at all costs."
Individual patients must be involved in decisions about their care, and this requires effective communication on the subject of risks, benefits, and side effects. Appropriate management of blood pressure should therefore be guided by an informed dialogue between patients and doctors and not by blind pursuit of blood pressure targets, they conclude.