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• W2463960866 abstract "HomeHypertensionVol. 68, No. 2Is It Time to Reappraise Blood Pressure Thresholds and Targets? Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toSupplementary MaterialsFree AccessResearch ArticlePDF/EPUBIs It Time to Reappraise Blood Pressure Thresholds and Targets?A Statement From the International Society of Hypertension—A Global Perspective Michael A. Weber, Neil R. Poulter, Aletta E. Schutte, Louise M. Burrell, Masatsugu Horiuchi, Dorairaj Prabhakaran, Agustin J. Ramirez, Ji-Guang Wang, Ernesto L. Schiffrin, and Rhian M. Touyz Michael A. WeberMichael A. Weber From the Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, New York (M.A.W.); International Centre for Circulatory Health, Imperial College London, United Kingdom (N.R.P.); MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa (A.E.S.); Department of Medicine, University of Melbourne, Victoria, Australia (L.M.B.); Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, Japan (M.H.); Department of Research and Policy, Public Health Foundation of India and Centre for Chronic Disease Control, Haryana, India (D.P.); Arterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.J.R.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.-G.W.); Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada (E.L.S.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.). Search for more papers by this author , Neil R. PoulterNeil R. Poulter From the Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, New York (M.A.W.); International Centre for Circulatory Health, Imperial College London, United Kingdom (N.R.P.); MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa (A.E.S.); Department of Medicine, University of Melbourne, Victoria, Australia (L.M.B.); Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, Japan (M.H.); Department of Research and Policy, Public Health Foundation of India and Centre for Chronic Disease Control, Haryana, India (D.P.); Arterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.J.R.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.-G.W.); Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada (E.L.S.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.). Search for more papers by this author , Aletta E. SchutteAletta E. Schutte From the Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, New York (M.A.W.); International Centre for Circulatory Health, Imperial College London, United Kingdom (N.R.P.); MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa (A.E.S.); Department of Medicine, University of Melbourne, Victoria, Australia (L.M.B.); Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, Japan (M.H.); Department of Research and Policy, Public Health Foundation of India and Centre for Chronic Disease Control, Haryana, India (D.P.); Arterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.J.R.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.-G.W.); Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada (E.L.S.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.). Search for more papers by this author , Louise M. BurrellLouise M. Burrell From the Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, New York (M.A.W.); International Centre for Circulatory Health, Imperial College London, United Kingdom (N.R.P.); MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa (A.E.S.); Department of Medicine, University of Melbourne, Victoria, Australia (L.M.B.); Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, Japan (M.H.); Department of Research and Policy, Public Health Foundation of India and Centre for Chronic Disease Control, Haryana, India (D.P.); Arterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.J.R.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.-G.W.); Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada (E.L.S.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.). Search for more papers by this author , Masatsugu HoriuchiMasatsugu Horiuchi From the Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, New York (M.A.W.); International Centre for Circulatory Health, Imperial College London, United Kingdom (N.R.P.); MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa (A.E.S.); Department of Medicine, University of Melbourne, Victoria, Australia (L.M.B.); Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, Japan (M.H.); Department of Research and Policy, Public Health Foundation of India and Centre for Chronic Disease Control, Haryana, India (D.P.); Arterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.J.R.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.-G.W.); Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada (E.L.S.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.). Search for more papers by this author , Dorairaj PrabhakaranDorairaj Prabhakaran From the Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, New York (M.A.W.); International Centre for Circulatory Health, Imperial College London, United Kingdom (N.R.P.); MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa (A.E.S.); Department of Medicine, University of Melbourne, Victoria, Australia (L.M.B.); Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, Japan (M.H.); Department of Research and Policy, Public Health Foundation of India and Centre for Chronic Disease Control, Haryana, India (D.P.); Arterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.J.R.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.-G.W.); Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada (E.L.S.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.). Search for more papers by this author , Agustin J. RamirezAgustin J. Ramirez From the Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, New York (M.A.W.); International Centre for Circulatory Health, Imperial College London, United Kingdom (N.R.P.); MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa (A.E.S.); Department of Medicine, University of Melbourne, Victoria, Australia (L.M.B.); Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, Japan (M.H.); Department of Research and Policy, Public Health Foundation of India and Centre for Chronic Disease Control, Haryana, India (D.P.); Arterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.J.R.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.-G.W.); Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada (E.L.S.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.). Search for more papers by this author , Ji-Guang WangJi-Guang Wang From the Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, New York (M.A.W.); International Centre for Circulatory Health, Imperial College London, United Kingdom (N.R.P.); MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa (A.E.S.); Department of Medicine, University of Melbourne, Victoria, Australia (L.M.B.); Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, Japan (M.H.); Department of Research and Policy, Public Health Foundation of India and Centre for Chronic Disease Control, Haryana, India (D.P.); Arterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.J.R.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.-G.W.); Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada (E.L.S.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.). Search for more papers by this author , Ernesto L. SchiffrinErnesto L. Schiffrin From the Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, New York (M.A.W.); International Centre for Circulatory Health, Imperial College London, United Kingdom (N.R.P.); MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa (A.E.S.); Department of Medicine, University of Melbourne, Victoria, Australia (L.M.B.); Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, Japan (M.H.); Department of Research and Policy, Public Health Foundation of India and Centre for Chronic Disease Control, Haryana, India (D.P.); Arterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.J.R.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.-G.W.); Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada (E.L.S.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.). Search for more papers by this author , and Rhian M. TouyzRhian M. Touyz From the Division of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, New York (M.A.W.); International Centre for Circulatory Health, Imperial College London, United Kingdom (N.R.P.); MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa (A.E.S.); Department of Medicine, University of Melbourne, Victoria, Australia (L.M.B.); Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Ehime, Japan (M.H.); Department of Research and Policy, Public Health Foundation of India and Centre for Chronic Disease Control, Haryana, India (D.P.); Arterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.J.R.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.-G.W.); Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada (E.L.S.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.M.T.). Search for more papers by this author Originally published27 Jun 2016https://doi.org/10.1161/HYPERTENSIONAHA.116.07818Hypertension. 2016;68:266–268Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2016: Previous Version 1 IntroductionThe SPRINT (Systolic Blood Pressure Intervention Trial) findings,1 together with the publication of other major studies within the last year addressing how low blood pressure should be targeted to prevent cardiovascular events in patients with hypertension,2–4 support what we have known for a long time that: (1) blood pressure >115/75 mm Hg is associated with increased risk of cardiovascular disease and stroke, (2) blood pressure lowering is associated with reduced morbidity and mortality, (3) antihypertensive drugs reduce the incidence of hypertension-associated events, and (4) prevention of cardiovascular morbidity is largely related to blood pressure lowering per se, although other effects of the drugs used contribute to this benefit.The questions that are now posed, particularly in response to an editorial commentary by the Editors of this Journal,5 are the following: What is the threshold at which antihypertensive treatment should be initiated? and what target blood pressure should we strive for to achieve maximum benefit in patients with hypertension? SPRINT and other recent meta-analyses and trials provide new data that allow us to sharpen and refine recommendations for blood pressure targets in people with hypertension.1–4 Here, we will briefly address the questions in the worldwide context of hypertension.In hypertensive patients without diabetes mellitus, previous stroke or polycystic kidney disease, SPRINT has provided strong evidence that targeting systolic blood pressure of <120 mm Hg (as measured by an automated measurement protocol in the office)1 provides significantly stronger protection from cardiovascular events and death than the traditionally accepted target of <140 mm Hg. This study was conducted in a hypertensive patient cohort of intermediate-to-high cardiovascular risk. It should be highlighted that the target of 120 mm Hg in SPRINT was based on blood pressure readings using a defined protocol with an office automated device, where blood pressure was measured 3× in the absence of clinical personnel.1 On the basis of the known differences between readings obtained by automated devices and conventional measurements,6 this average would translate to higher readings (130 mm Hg) in clinical practice. Hence, if the goal were to reduce blood pressure to <120 mm Hg using conventional methods, there is a risk that blood pressures would in fact be lower than SPRINT’s 120 mm Hg, with unknown consequences, as highlighted in a recent editorial.7 Accordingly, it is critical that the SPRINT findings are interpreted in the context of the protocol that was used to measure blood pressure.Moreover, although SPRINT aimed for <120 mm Hg, it should be emphasized that the study did not actually achieve its target <120 mm Hg, with the intensively treated group having an overall systolic blood pressure of ≈122 mm Hg as recorded by the defined measurement protocol.1 Hence, considering the method used to measure the blood pressure, it may be more appropriate to conclude that SPRINT’s benefits were evident at conventional levels closer to 130 mm Hg, in line with other recent reports from individual trials and meta-analyses, which support a target of <130 mm Hg.2–4,8Importantly, the SPRINT findings do not exclude any particular patient subgroups, except diabetes mellitus and previous stroke. Indeed, black patients benefited equally as well as white, and the results in older patients (≥75 years) were at least as good as in the younger group. However, for patients aged >80 years, in whom safety data at this low blood pressure are still limited, it would be prudent to follow a cautious path in approaching the <130 mm Hg target.9 Regarding the safety concerns, mainly reductions in renal function, electrolyte abnormalities, and hypotensive symptoms, SPRINT suggests that the benefits of intensive management outweigh adverse outcomes for patients at heightened risk of events.It should be acknowledged, based on HOPE 3 (Heart Outcomes Prevention Evaluation 3),10 that there is some uncertainty about whether there is sufficient evidence to support the initiation of antihypertensive treatment in patients with systolic blood pressures of <140 mm Hg, particularly if other major cardiovascular risk factors are not present. It should be noted, however, that HOPE 3 did not test differing blood pressure targets.Because SPRINT excluded hypertensive patients with a history of diabetes mellitus or stroke, considerations for blood pressure targets in patients with diabetes mellitus need to be considered from data in other trials. For diabetic patients, the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes),11 supported by some but not all studies and meta-analyses, seems to suggest a systolic treatment target of <140 mm Hg is sufficient. The one caveat is stroke: in ACCORD and at least one other trial, stroke seemed to be best prevented at <120 mm Hg. But to further complicate decision-making, meta-analysis and individual trials suggest the possibility of increasing some fatal and nonfatal cardiovascular outcomes as well as adverse renal effects, if the pressure is reduced to <130 mm Hg or <120 mm Hg in patients with diabetes mellitus.12–14 Even so, given the serious and justifiably feared consequences of stroke and the inconsistency of the currently available evidence, clinicians should consider discussing the selection of treatment targets with their patients. Meanwhile, reaching a target of 130 mm Hg seems an acceptable compromise.A Global Perspective by the International Society of HypertensionThe International Society of Hypertension has a strong commitment to and interest in the work of preventing, identifying, and treating hypertensive patients throughout the world. We recognize that recommendations made for more prosperous nations cannot fully apply to all communities or to low and middle income countries. Indeed, hypertension diagnosis and management are often hampered by such fundamental problems due to the lack of blood pressure measuring devices, shortage of personnel trained to measure blood pressures, or to advise patients and initiate therapy. Basic laboratory procedures to check for concomitant conditions, such as diabetes mellitus or lipid disorders, may not be available. Moreover, although most modern antihypertensive agents are now produced in inexpensive generic formulations, their cost and availability still limit treatment in many parts of the world.In 2014, in collaboration with the American Society of Hypertension, International Society of Hypertension published Guidelines on the Treatment of Hypertension in the Community.15 Although those guidelines recommended a systolic blood pressure of 140 mm Hg as the usual hypertension threshold, they recognized that in several parts of the world, this could put an excessive burden on limited budgets. So, it was suggested for patients without other risk factors, and with systolic blood pressures <160 mm Hg, that initial treatment could be based on lifestyle modifications alone. But even this suggestion, although well intended, could not address the reality that resources to identify additional risk factors in hypertensive patients are often lacking in low-income areas and that, in any case, lifestyle modifications that require dietary adjustments, other than moderation of salt intake, are often unavailable or unaffordable. These challenges may be further compounded by insufficient or ineffective education of healthcare providers, policy makers, and the population.The findings from SPRINT and the other new reports of the benefits of aggressive therapy emphasize that many underserved hypertensive patients are now even more remote from optimal care. This could be a compelling concern in Africa given the strong benefits achieved by the black patients in SPRINT. In African and many other developing countries, overcrowded clinics are dealing mostly with infectious diseases. We, therefore, anticipate that the wide publicity given by SPRINT and other new high-impact reports will help bring a sense of urgency to resolving this major public health issue, which has more wide-ranging environmental challenges beyond aggressive antihypertensive therapy alone.Taking into consideration the global target population of interest to the International Society of Hypertension, together with evidence derived from SPRINT and other recent meta-analyses and clinical trials, the practical message from the International Society of Hypertension is to strive for a systolic blood pressure target of 130 mm Hg in most patients with hypertension. This is especially important considering that blood pressure measurements in the community are not likely to be performed using the SPRINT protocol. So, advocating a target of <120 mm Hg is not justified in clinical practice, and in any case would incur the costs of increased clinic visits, more intensive health care, and more medications. In regions of low resources, this added financial and logistical burden is not tenable. Accordingly, although we recognize that there might be benefits in targeting treatment to below our recommended level of 130 mm Hg in nondiabetic hypertensive patients at high cardiovascular risk (as in the SPRINT population), the International Society of Hypertension thinks it is premature to advocate such low targets at a global level.Sources of FundingR.M. Touyz is supported through a Chair from the British Heart Foundation (CH/12/4/29762). E.L. Schiffrin is supported by a Canada Research Chair (CRC) on Hypertension and Vascular Research by the CRC Government of Canada/Canadian Institutes of Health Research Program. A.E. Schutte is supported by the South African Medical Research Council and a South African Research Chair (SARChI) by the National Research Foundation.DisclosuresNone.FootnotesThe opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.This article was sent to Daniel W. Jones, Guest Editor, for review by expert referees, editorial decision, and final disposition.Correspondence to Rhian M. Touyz, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, United Kingdom. E-mail [email protected]References1. The SPRINT Research Group. A randomized trial of intensive versus standard blood pressure control.N Engl J Med. 2015; 373:2103–2116. doi: 10.1056/NEJMoa1511939.CrossrefMedlineGoogle Scholar2. Xie X, Atkins E, Lv J, et al.. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis.Lancet. 2016; 387:435–443. doi: 10.1016/S0140-6736(15)00805-3.CrossrefMedlineGoogle Scholar3. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.Lancet. 2016; 387:957–967. doi: 10.1016/S0140-6736(15)01225-8.CrossrefMedlineGoogle Scholar4. Weber MA, Lackland DT. Hypertension: Cardiovascular benefits of lowering blood pressure.Nat Rev Nephrol. 2016; 12:202–204. doi: 10.1038/nrneph.2016.27.CrossrefMedlineGoogle Scholar5. Touyz RM, Dominiczak AF. Hypertension guidelines: is it time to reappraise blood pressure thresholds and targets?Hypertension. 2016; 67:688–689. doi: 10.1161/HYPERTENSIONAHA.116.07090.LinkGoogle Scholar6. Myers MG, Kaczorowski J, Paterson JM, Dolovich L, Tu K. Thresholds for Diagnosing Hypertension Based on Automated Office Blood Pressure Measurements and Cardiovascular Risk.Hypertension. 2015; 66:489–495. doi: 10.1161/HYPERTENSIONAHA.115.05782.LinkGoogle Scholar7. Schiffrin EL, Calhoun DA, Flack JM. SPRINT proves that lower is better for nondiabetic high-risk patients, but at a price.Am J Hypertens. 2016; 29:2–4. doi: 10.1093/ajh/hpv190.CrossrefMedlineGoogle Scholar8. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels - updated overview and meta-analyses of randomized trials.J Hypertens. 2016; 34:613–622. doi: 10.1097/HJH.0000000000000881.CrossrefMedlineGoogle Scholar9. Wright JT, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view.Ann Intern Med. 2014; 160:499–503. doi: 10.7326/M13-2981.CrossrefMedlineGoogle Scholar10. Lonn EM, Bosch J, López-Jaramillo P, et al.; HOPE-3 Investigators. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease.N Engl J Med. 2016; 374:2009–2020. doi: 10.1056/NEJMoa1600175.CrossrefMedlineGoogle Scholar11. Cushman WC, Evans GW, Byington RP, et al.. Effects of intensive blood pressure control in type 2 diabetes mellitus.N Engl J Med. 2010; 362:1575–1585.CrossrefMedlineGoogle Scholar12. Cooper-DeHoff RM, Gong Y, Handberg EM, Bavry AA, Denardo SJ, Bakris GL, Pepine CJ. Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease.JAMA. 2010; 304:61–68. doi: 10.1001/jama.2010.884.CrossrefMedlineGoogle Scholar13. Brunström M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses.BMJ. 2016; 352:i717.CrossrefMedlineGoogle Scholar14. Weber MA, Bloch M, Bakris GL, Weir MR, Zappe DH, Dahlof B, Velazquez EJ, Pitt B, Basile JN, Jamerson K, Hua TA. Cardiovascular Outcomes According to Systolic Blood Pressure in Patients With and Without Diabetes: An ACCOMPLISH Substudy.J Clin Hypertens (Greenwich). 2016; 18:299–307. doi: 10.1111/jch.12816.CrossrefMedlineGoogle Scholar15. Weber MA, Schiffrin EL, White WB, et al.. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension.J Hypertens. 2014; 32:3–15. doi: 10.1097/HJH.0000000000000065.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByDominiczak A and Kuo D (2017) Hypertension: Update 2018, Hypertension, 71:1, (3-4), Online publication date: 1-Jan-2018.Poulter N, Castillo R, Charchar F, Schlaich M, Schutte A, Tomaszewski M, Touyz R and Wang J (2018) Are the American Heart Association/American College of Cardiology High Blood Pressure Guidelines Fit for Global Purpose?: Thoughts From the International Society of Hypertension, Hypertension, 72:2, (260-262), Online publication date: 1-Aug-2018.Dominiczak A and Kuo D (2016) Hypertension: Update 2017, Hypertension, 69:1, (3-4), Online publication date: 1-Jan-2017.Dzeshka M, Shantsila A, Shantsila E and Lip G (2017) Atrial Fibrillation and Hypertension, Hypertension, 70:5, (854-861), Online publication date: 1-Nov-2017.Koh K (2017) Letter by Koh Regarding Article, “Potential Deaths Averted and Serious Adverse Events Incurred From Adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) Intensive Blood Pressure Regimen in the United States: Projections From NHANES (National Health and Nutrition Examination Survey)”, Circulation, 136:12, (1172-1173), Online publication date: 19-Sep-2017. August 2016Vol 68, Issue 2Article InformationMetrics Download: 163 © 2016 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.116.07818PMID: 27354426 Originally publishedJune 27, 2016 PDF download SubjectsHypertension" @default.
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