Target goal blood pressure in hypertension management

Hae-Young Lee

doi:10.5124/jkma.2017.60.10.819

J Korean Med Assoc > Volume 60(10); 2017 > Article

Lee: Target goal blood pressure in hypertension management

Original Article

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

Published online: October 17, 2017

DOI: http://dx.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 September 10, 2017 Accepted September 24, 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.

Key words: Hypertension; Blood pressure; Cardiovascular risk

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.

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