Intensive blood pressure lowering: a practical review
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REVIEW
Open Access
Intensive blood pressure lowering: a practical review Miguel Camafort1,2,3* , Josep Redón3,4, Wook Bum Pyun5 and Antonio Coca1,2
Abstract According to the last Hypertension guideline recommendations, it may be concluded that intensive BP lowering is only advisable in a subgroup of patients where there is a clear net benefit of targeting to lower BP goals. However, taking into account the relevance of correct BP measurement, estimates of the benefits versus the harm should be based on reliable office BP measurements and home BP measurements. There is still debate about which BP goals are optimal in reducing morbidity and mortality in uncomplicated hypertensives and in those with associated comorbidities. In recent years, trials and meta-analyses have assessed intensive BP lowering, with some success. However, a careful examination of the results shows that current data are not easily applicable to the general hypertensive population. This article reviews the evidence on and controversies about intensive BP lowering in general and in specific clinical situations, and the importance of obtaining reliable BP readings in patients with hypertension and comorbidities. Keywords: Intensive blood pressure lowering, Ageing, Obesity, cardiovascular risk, Diabetes mellitus type 2, Ischemic heart disease, Chronic kidney disease, Heart failure, Ambulatory blood pressure measurement
Background Recently, we have experienced a change, in Hypertension Guidelines recommendations, to a more intensive lowering of BP levels. These changes are based on some trials that are far from including different hypertensive populations and therefore should be only applied to this populations. On the other hand, intensive BP lowering should be applied only when there is a clear balance in favour of benefits against adverse effects or harm caused by intensive BP lowering. This article reviews the evidence on and controversies about intensive BP lowering in general and in specific clinical situations, and the importance of obtaining reliable BP readings in patients with hypertension and comorbidities. * Correspondence: [email protected] 1 Department of Internal Medicine-ICMiD. Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain 2 Cardiovascular Risk, Nutrition and Aging Research Group. IDIBAPS, Barcelona, Spain Full list of author information is available at the end of the article
How low should we go? Hypertension (HT) is defined as non-optimal levels of measured blood pressure (BP). More specifically, the ESH/ESC 2018 Guidelines on Hypertension, defines HT as the level of BP at which the benefits of treatment unequivocally outweigh the risks of treatment, as documented by clinical trials [1]. The importance of HT is increasing daily due to its high prevalence. For example, in 2010, it was estimated that one third of the total adult population worldwide was hypertensive; interestingly the percentage in high, low and middle-income countries was similar [2]. Currently, it is estimated that HT affe
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