Facts and fallacies of blood pressure control in recent trials: implications in the management of patients with hypertension
- 1 April 2009
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal Of Hypertension
- Vol. 27 (4), 673-679
- https://doi.org/10.1097/hjh.0b013e3283298ea2
Abstract
A large body of clinical trial data indicates that a given difference in blood pressure (BP), as measured in the clinic, results in a given difference in outcome. This correlation underpins current US and European guidelines for the management of hypertension. However, findings from recent comparative trials may appear inconsistent with a fixed relationship between BP lowering and outcome benefit, at least at all BP ranges, at all levels of total cardiovascular risk and with all drug combinations. We review the findings of six of these recent trials and conclude that their complex design precludes a simple interpretation, that several important questions remain unanswered and that direct evidence – particularly in support of lowering systolic BP below 140 or 130 mmHg – is urgently needed.Keywords
This publication has 36 references indexed in Scilit:
- Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular EventsNew England Journal of Medicine, 2008
- Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trialThe Lancet, 2007
- 2007 Guidelines for the Management of Arterial HypertensionJournal Of Hypertension, 2007
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureHypertension, 2003
- Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trialsThe Lancet, 2003
- Cardiovascular prevention and blood pressure reductionJournal Of Hypertension, 2003
- 2003 European Society of Hypertension???European Society of Cardiology guidelines for the management of arterial hypertension*Journal Of Hypertension, 2003
- Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studiesThe Lancet, 2002
- Blood pressure, stroke, and coronary heart diseaseThe Lancet, 1990
- Blood pressure, stroke, and coronary heart disease *1Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution biasThe Lancet, 1990