Abstract
The optimal target blood pressure in the treatment of hypertension is undefined. Whether
more intense therapy is better than standard, typically <140/90 mm Hg, is controversial.
The most recent American guidelines recommend ≤130/80 mm Hg for essentially all adults.
There have been at least 28 trials targeting more versus less intensive therapy, including
13 aimed at reducing cardiovascular events and mortality, 11 restricted to patients
with chronic kidney disease, and 4 with surrogate endpoints. We review these trials
in a narrative fashion due to significant heterogeneity in targets chosen, populations
studied, and primary endpoints. Most were negative, although some showed significant
benefit to more intense therapy. When determining the optimal pressure for an individual
patient, additional factors should be considered, including age, frailty, polypharmacy,
baseline blood pressure, and the diastolic blood pressure J-curve. We discuss these
modifying factors in detail. Whereas the tenet “lower is better” is generally true,
one size does not fit all, and blood pressure control must be individualized.
Key words
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Article Info
Publication History
Published online: May 27, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: None.
Conflicts of Interest: EJF reports serving on the speakers bureau for AstraZeneca. AJF reports none. GVN reports serving as a consultant to Sanofi, Glaxo Smith Kline, Acesion, and Milestone.
Authorship: All authors had access to the data and a role in writing this manuscript.
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