Treatment blood pressure targets for hypertension

Aiming for lower than standard blood pressure targets offers no known clinical benefit, according to a Cochrane Review. In a systematic review of the evidence, researchers found that using antihypertensive drugs to reduce blood pressure below the 140/90 mm Hg standard was not associated with any reduction in death rates or serious morbidity.

"At present there is no evidence from randomized trials to support aiming for a blood pressure target lower than 140/90, in the general population of patients with elevated blood pressure," says lead researcher Jose Arguedas of the Faculty of Medicine at the University of Costa Rica in Costa Rica.

The findings do not support guidelines in a number of publications that recommend aiming for lower targets, based on the assumption that "lower is better" when it comes to blood pressure. The researchers were unable to determine whether it is safe to aim for lower targets because relevant data was missing from most of the trials.

The review is based on the results of seven trials, which together involved 22,089 people. Whilst patients aiming for targets below 135/85 mmHg did succeed in achieving greater reductions in blood pressure than those in the standard target group, there was no difference between the two groups in terms of the number of patients dying or suffering heart attacks, strokes, heart failure or kidney failure.

"Our research included patients with diabetes or chronic renal disease, and the evidence was slightly less robust for those subgroups of patients. We intend to carry out separate systematic reviews for those subgroups, especially because guidelines recommend even lower blood pressure targets for them", says Arguedas.

Full bibliographic information: Arguedas JA, Perez MI, Wright JM. Treatment blood pressure targets for hypertension. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD004349. DOI: 10.1002/14651858.CD004349.pub2.

http://www.cochrane.org/reviews/

Comments

  1. Glen Edwards Glen Edwards United States says:

    My blood pressure has been 140/90 for the last 25+ years.  Recently the medical community here in Minnesota has been pressuring me to aim for 120/70.  I tried a prescription diuretic.  It didn't lower my pressure at all, and I developed purple bruising in my right arm.  Atenolol did lower my pressure, but the side effects were less than desirable, so I quit it.  I'm currently not taking any blood pressure medication.  I feel fine.  At 50 I'm going to the gym 3 times a week and spending an hour on the elliptical stepper burning 1050 to 1085 calories.  My resting heart rate is in the mid 70's.  I work 45+ hours a week, at 6' 2" and 220 lbs am slightly over my ideal weight.  I watch my diet closely.  I really wish the medical community would have a more realistic target for blood pressure.  Attempts at lowering it left me feeling miserable.

  2. Glen Lee Edwards Glen Lee Edwards United States says:

    The published standard for taking blood pressure is for the arm to be elevated so that the elbow is level with the heart.  My job requires that I take a physical every 2 years.  In Minnesota where I live, all but one of the clinics I've visited take blood pressure with the arm straight down at the side.  I've tried it both ways at home.  I see an increase in 15 - 20 mm HG with the arm hanging down.  If this is typical, then in order to reach the target rate of 120/70, one would have to have a real blood pressure of 100/50.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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