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Blood Pressure Targets with Antihypertensive Treatment

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Special Issues in Hypertension

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Abstract

This chapter discusses the issue of achieving target blood pressure values in uncomplicated and complicated hypertensive patients. The recommendations made in the 2007 by the European guidelines on hypertension, as well as data provided by the most recent clinical trials, are discussed. There is then an analysis of (1) the so-called J-shaped curve phenomenon, which is related to the potential adverse effects of excessive blood pressure lowering interventions on cardiovascular events and (2) target ambulatory and home blood pressure values. The limitations and problems of current information related to target blood pressure values to be achieved during treatment, particularly in older hypertensive patients, are highlighted.

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References

  1. Mancia G, De Backer G, Dominiczak A et al, Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology (2007) 2007 guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). J Hypertens 25:1105–1187

    Article  Google Scholar 

  2. Turnbull F, Neal B, Ninomiya T et al (2008) Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. Blood pressure lowering treatment trialists’ collaboration. BMJ 336:1121–1123

    Article  PubMed  CAS  Google Scholar 

  3. Law MR, Morris JK, Wald NJ (2009) Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 338:b1665. doi:10.1136/bmj.b1665

    Article  PubMed  CAS  Google Scholar 

  4. Turnbull F, Blood Pressure Lowering Treatment Trialists’ Collaboration (2003) Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 362:1527–1535

    Article  Google Scholar 

  5. Chobanian AV, Bakris GL, Black HR, et al, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289:2560–2572

    Google Scholar 

  6. Whitworth JA; World Health Organization, International Society of Hypertension Writing Group (2003) 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 21:1983–1992

    Article  Google Scholar 

  7. Lewington S, Clarke R, Qizilbash N et al (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Prospective studies collaboration. Lancet 360:1903–1913

    Article  PubMed  Google Scholar 

  8. Polese A, De Cesare N, Montorsi P et al (1991) Upward shift of the lower range of coronary flow autoregulation in hypertensive patients with hypertrophy of the left ventricle. Circulation 83:845–853

    Article  PubMed  CAS  Google Scholar 

  9. Zanchetti A, Grassi G, Mancia G (2009) When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? A critical reappraisal. J Hypertens 27:923–934

    Article  PubMed  CAS  Google Scholar 

  10. Mancia G, Laurent S, Agabiti-Rosei E et al (2009) Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. European Society of Hypertension. J Hypertens 27:2121–2158

    Article  PubMed  CAS  Google Scholar 

  11. Beckett NS, Peters R, Fletcher AE et al, HYVET Study Group (2008) Treatment of hypertension in patients 80 years of age or older. N Engl J Med 358:1887–1898

    Article  Google Scholar 

  12. Weber MA, Julius S, Kjeldsen SE et al (2004) Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE Trial. Lancet 363:2049–2051

    Article  PubMed  CAS  Google Scholar 

  13. Mancia G, Messerli F, Bakris G et al (2007) Blood pressure control and improved cardiovascular outcomes in the international verapamil SR-Trandolapril study. Hypertension 50:299–305

    Article  PubMed  CAS  Google Scholar 

  14. Zhang Y, Zhang X, Liu L et al, FEVER Study Group (2010) Effects of individual risk factors on the residual risk of cardiovascular events in a population of treated Chinese patients with hypertension: data from the felodipine event reduction (FEVER) study. J Hypertens 28:2016–2025

    Google Scholar 

  15. McMurray JJ, Holman RR, Haffner SM et al, NAVIGATOR Study Group (2010) Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med 362:1477–1490

    Article  Google Scholar 

  16. Mancia G, Bombelli M, Facchetti R et al (2008) Long-term risk of diabetes, hypertension and left ventricular hypertrophy associated with the metabolic syndrome in a general population. J Hypertens 26:1602–1611

    Article  PubMed  CAS  Google Scholar 

  17. ACCORD Study Group, Cushman WC, Evans GW, Byington RP et al (2010) Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 362:1575–1585

    Google Scholar 

  18. Cooper-DeHoff RM, Gong Y, Handberg EM et al (2010) Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA 304:61–68

    Article  PubMed  CAS  Google Scholar 

  19. Sleight P, Redon J, Verdecchia P et al, ONTARGET investigators (2009) Prognostic value of blood pressure in patients with high vascular risk in the ongoing Telmisartan Alone and in combination with Ramipril global endpoint trial study. J Hypertens 27:1360–1369

    Google Scholar 

  20. Mancia G, Schumacher H, Redon J et al (2011) Blood pressure targets recommended by guidelines and incidence of cardiovascular and renal events in the ongoing Telmisartan alone and in combination with Ramipril global endpoint trial (ONTARGET). Circulation 124:1727–1736

    Article  PubMed  Google Scholar 

  21. Mancia G, Messerli FH, Weber MA et al (2009) Association between the proportion of time under blood pressure (BP) control and cardiovascular (CV) morbidity and mortality in the VALUE trial. J Hypertens 27:S327

    Google Scholar 

  22. Arima H, Chalmers J, Woodward M et al, PROGRESS Collaborative Group (2006) Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial. J Hypertens 24:1201–1208

    Article  Google Scholar 

  23. Ovbiagele B, Diener HC, Yusuf S et al, PROFESS Investigators (2011) Level of systolic blood pressure within the normal range and risk of recurrent stroke. JAMA 306:2137–2144

    Google Scholar 

  24. Vickrey BG, Rector TS, Wickstrom SL et al (2002) Occurrence of secondary ischemic events among persons with atherosclerotic vascular disease. Stroke 33:901–906

    Article  PubMed  Google Scholar 

  25. Zanchetti A (2010) Blood pressure targets of antihypertensive treatment: up and down the J-shaped curve. Eur Heart J 31:2837–2840

    Article  PubMed  CAS  Google Scholar 

  26. Boutitie F, Gueyffier F, Pocock S et al, INDANA Project Steering Committee. INdividual Data ANalysis of Antihypertensive intervention (2002) J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med 136:438–448

    Google Scholar 

  27. Redon J, Mancia G, Sleight P et al, ONTARGET Investigators (2012) Safety and efficacy of low blood pressures among patients with diabetes: subgroup analyses from the ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial). J Am Coll Cardiol 59:74–83

    Google Scholar 

  28. Mancia G, Zanchetti A, Agabiti-Rosei E et al (1997) Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. SAMPLE study group. Study on ambulatory monitoring of blood pressure and Lisinopril evaluation. Circulation 95:1464–1470

    Article  PubMed  CAS  Google Scholar 

  29. Zanchetti A, Bond MG, Hennig M et al, European Lacidipine Study on Atherosclerosis investigators (2002) Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis: principal results of the European Lacidipine Study on Atherosclerosis (ELSA), a randomized, double-blind, long-term trial. Circulation 106:2422–2427

    Article  Google Scholar 

  30. Mancia G, Sega R, Bravi C et al (1995) Ambulatory blood pressure normality: results from the PAMELA study. J Hypertens 13:1377–1390

    Article  PubMed  CAS  Google Scholar 

  31. Staessen J, Bulpitt CJ, Fagard R et al (1991) Reference values for the ambulatory blood pressureambulatory blood pressure and the blood pressure measured at home: a population study. J Hum Hypertens 5:355–361

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università Milano-Bicocca, Fondazione Ipertensione e Prevenzione Cardiovascolare, Milan, Italy

    Giuseppe Mancia

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  1. Giuseppe Mancia
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Correspondence to Giuseppe Mancia .

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Editors and Affiliations

  1. , Internal Medicine, American University of Beirut Medical Ce, Riad El Solh, Beirut, 1107-2020, Lebanon

    Adel E. Berbari

  2. Clinica Medica, Ospedale S. Gerardo, Università di Milano-Bicocca, V .Donizetti 106, Milano, Monza, 20133, Italy

    Giuseppe Mancia

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Mancia, G. (2012). Blood Pressure Targets with Antihypertensive Treatment. In: Berbari, A., Mancia, G. (eds) Special Issues in Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-2601-8_21

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  • DOI: https://doi.org/10.1007/978-88-470-2601-8_21

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  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2600-1

  • Online ISBN: 978-88-470-2601-8

  • eBook Packages: MedicineMedicine (R0)

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