Treating high systolic blood pressure in nondiabetic patients could be beneficial

August 13, 2009

Treatment to lower high systolic blood pressure in non-diabetic patients is associated with a reduction in left ventricular hypertrophy (LVH), a thickening of the heart muscle that can lead to heart failure and rhythm problems. Thus, a lowering of systolic blood pressure targets from the currently recommended 140 mm/Hg or less to below 130 mm Hg should be the treatment goal in low-risk patients with high blood pressure, concludes an Article published in this week's edition of The Lancet.

Despite a lack of evidence, hypertension guidelines recommend that blood pressure be lowered to less than 140/90 mm Hg. Evidence from previous trials does lend support to a blood pressure target of below 130/80mm Hg in high-risk patients with cardiovascular disease or diabetes. However, the level to which systolic blood pressure should be lowered in patients without high cardiovascular risk has not been evaluated in clinical trials. Indeed, there is currently no evidence to support a lower treatment target in patients with high blood pressure without diabetes.

For the first time, Paolo Verdecchia from the Hospital S. Maria della Misericordia and ANMO Research Centre in Italy and colleagues conducted a randomised trial to examine the cardiovascular effects of a systolic blood pressure target below 130 mm Hg (tight control) compared with a target below 140 mm Hg (usual control) in non-diabetic patients with hypertension.

In total, 1111 non-diabetic patients aged 55 years or older with a systolic blood pressure of 150 mm Hg or higher were recruited from 44 centres in Italy between 2005 and 2007. Patients were randomly assigned to a target systolic blood pressure of less than 140 mm Hg (553) or less than 130 mm Hg (558). Antihypertensive drugs were used to lower blood-pressure and tailored to individual patients' needs. Blood pressure was checked every 4 months for 2 years and at the final 2-year visit patients were tested for LVH.

Over 2 years, tight (< 130 mm Hg) compared to usual (< 140 mm Hg) blood-pressure control reduced systolic blood pressure and decreased the likelihood of LVH and clinical events. Overall, systolic blood pressure was 3.8 mm Hg lower and diastolic blood pressure 1.5 mm Hg lower in the tight-control group. In addition, patients in the usual-control group were more likely to have LVH (17%) than in the tight-control group (11.4%) at 2 years. Although the number of events of clinical outcome was small, coronary revascularisation and new-onset atrial fibrillation were significantly less frequent in the tight-control group.

The authors conclude: "Because of the poor amount of blood-pressure control in the general population and clinical trials, and because of the direct relation between cardiovascular protection and blood-pressure lowering, the results...lend support to a lower blood pressure goal than is recommended at present in non-diabetic patients with hypertension."

In an accompanying Comment, Bo Carlberg from University Hospital, Umeå, Sweden, cautions that before changing guidelines in low-risk patients with hypertension: "A systolic blood pressure treatment goal below 130 mm Hg should be evaluated in adequately powered randomised trials. Only after that will it be possible to evaluate in which groups of patients such treatment is beneficial and the cost effectiveness of such treatment."
-end-
Dr Paolo Verdecchia, Hospital S. Maria della Misericordia, Perugia, Italy. T) +39 (075) 5782213; 5782207; 5782476; 5782478 E) verdec@tin.it

Dr Bo Carlberg, University Hospital, Umeå, Sweden. T) +46 70 577 5883 E) bo.carlberg@medicin.umu.se

For full Article and Comment, see: http://press.thelancet.com/hypertensionbp.pdf

Lancet

Related Blood Pressure Articles from Brightsurf:

Children who take steroids at increased risk for diabetes, high blood pressure, blood clots
Children who take oral steroids to treat asthma or autoimmune diseases have an increased risk of diabetes, high blood pressure, and blood clots, according to Rutgers researchers.

High blood pressure treatment linked to less risk for drop in blood pressure upon standing
Treatment to lower blood pressure did not increase and may decrease the risk of extreme drops in blood pressure upon standing from a sitting position.

Changes in blood pressure control over 2 decades among US adults with high blood pressure
National survey data were used to examine how blood pressure control changed overall among U.S. adults with high blood pressure between 1999-2000 and 2017-2018 and by age, race, insurance type and access to health care.

Transient increase in blood pressure promotes some blood vessel growth
Blood vessels are the body's transportation system, carrying oxygen and nutrients to cells and whisking away waste.

Effect of reducing blood pressure medications on blood pressure control in older adults
Whether the amount of blood pressure medications taken by older adults could be reduced safely and without a significant change in short-term blood pressure control was the objective of this randomized clinical trial that included 534 adults 80 and older.

Brain blood flow sensor discovery could aid treatments for high blood pressure & dementia
A study led by researchers at UCL has discovered the mechanism that allows the brain to monitor its own blood supply, a finding in rats which may help to find new treatments for human conditions including hypertension (high blood pressure) and dementia.

Here's something that will raise your blood pressure
The apelin receptor (APJ) has been presumed to play an important role in the contraction of blood vessels involved in blood pressure regulation.

New strategy for treating high blood pressure
The key to treating blood pressure might lie in people who are 'resistant' to developing high blood pressure even when they eat high salt diets, shows new research published today in Experimental Physiology.

Arm cuff blood pressure measurements may fall short for predicting heart disease risk in some people with resistant high blood pressure
A measurement of central blood pressure in people with difficult-to-treat high blood pressure could help reduce risk of heart disease better than traditional arm cuff readings for some patients, according to preliminary research presented at the American Heart Association's Hypertension 2019 Scientific Sessions.

Heating pads may lower blood pressure in people with high blood pressure when lying down
In people with supine hypertension due to autonomic failure, a condition that increases blood pressure when lying down, overnight heat therapy significantly decreased systolic blood pressure compared to a placebo.

Read More: Blood Pressure News and Blood Pressure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.