What is goal blood pressure in the treatment of hypertension?
- Johannes FE Mann, MD
Johannes FE Mann, MD
- Professor of Medicine
- Friedrich Alexander University of Erlangen-Nürnberg
- International Scholar, Population Health Research Institute, McMaster University, Canada
- Karl F Hilgers, MD
Karl F Hilgers, MD
- Professor of Internal Medicine and Hypertension Research
- Friedrich-Alexander University, Erlangen-Nuremberg
- Vice Chair, Department of Nephrology and Hypertension
- Erlangen University Hospital
- Section Editors
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
An increasing number of trials have provided evidence that antihypertensive therapy to attain blood pressure control provides some degree of cardiovascular protection. However, the optimal level of control may vary across certain patient populations [1,2]. In general, the benefits of increasingly intensive therapy must be weighed against the potentially increased incidence of serious side effects associated with such a regimen.
The rationale for specific goal blood pressure levels in the general hypertensive population, the possible risks of excessive blood pressure lowering, and our approach to setting blood pressure goals will be reviewed here.
Separate issues related to the management of hypertension are presented elsewhere, including:
●Treatment of hypertension in patients with diabetes (see "Treatment of hypertension in patients with diabetes mellitus")
●Treatment of hypertension in patients with nondiabetic chronic kidney disease (CKD) (see "Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults")
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- OUR APPROACH TO GOAL BLOOD PRESSURE
- NATURAL HISTORY OF BLOOD PRESSURE AND RELATION TO CARDIOVASCULAR DISEASE
- EVIDENCE OF BENEFIT FROM TREATING HYPERTENSION
- Systolic and diastolic hypertension
- - Benefit according to severity of hypertension
- Benefit in those with severe hypertension
- Benefit in those with moderate hypertension
- Benefit in those with mild hypertension
- - Benefit according to overall cardiovascular risk
- Isolated systolic hypertension
- J-SHAPED CURVE AND QUESTION OF HARM FROM LOWER BLOOD PRESSURE
- J-shaped diastolic curve
- - Positive studies
- - Negative studies
- - HOT trial
- J-shaped systolic curve
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS