A recent review suggests that for most individuals, the ideal blood pressure target is not 120/80mmHg, but actually somewhere below 140/90mmHg. It also discusses the management of hypertension with the latest drug treatments.
Hypertension, also known as high blood pressure, is a disease that affects almost a quarter of all adults living in the United States. Despite a lack of symptoms, having high blood pressure can increase your likelihood of suffering from adverse cardiovascular events such as stroke or heart failure, thereby increasing the risk of death. With such a high prevalence in society, it is no wonder that research on causes and potential treatments for hypertension is a priority. A recent article published in Current Opinion Cardiology reviewed the latest information and laid out ideal blood pressure targets and drug therapies in the hopes of reducing the impact of hypertension.
Contrary to popular belief, the ideal blood pressure is not 120/80mmHg. While individual histories must be taken into account, the general consensus is that having a blood pressure less than 140/90mmHg is considered to be healthy. In fact, a recent trial looked at the risk of cardiovascular events for diabetic individuals with systolic blood pressures below 120mmHg and those below 140mmHg. The results indicated that other than the reduced risk of stroke, having a systolic blood pressure below 120mmHg had no benefits. Interestingly, this lower blood pressure was actually associated with an increased risk of negative cardiovascular events. These results can be generalized not just to diabetics, but also to those without coronary artery disease (CAD). Additionally, data from other sources suggests that maintaining a systolic blood pressure of around 120mmHg requires the use of multiple medications, which can affect compliance to the drug regimen.
For those with CAD, finding an ideal blood pressure has been more complicated. Most sources indicate that having a blood pressure on the lower end of the scale can result in an increased risk of cardiovascular events, such as the development of angina (chest pain). Opposite to this, is the SPRINT trial, which looked at over 9000 non-diabetic individuals and found that lowering their systolic blood pressure to below 120mmHg led to a reduced risk of death and heart failure. However, critics suggest that due to methodology, the 120mmHg observed in this study may equate to 130-135mmHg in other settings. This means that these results should be interpreted with caution.
Management of hypertension is mainly carried out through medications. There are a variety of drug classes that prove beneficial in treating hypertension including renin-angiotensin aldosterone blockade (RAAS) blockers, calcium channel blockers (CCBs), and diuretics. Some individuals also use beta-blockers, but this is now considered a third line defense, and is only used if other options are unviable. RAAS blockers are effective at reducing blood pressure, but are especially good at treating those who also suffer from diabetes or CAD. However, there is some discussion that a subclass of RAAS blockers known as ACE inhibitors (ACEi) do not work as effectively in black patients. This information should be considered when determining a treatment method. Additionally, calcium channel blockers are considered to be an effective method of treatment, working at also reducing the risk of cardiovascular events, similar to some diuretics.
This review provides new information on the treatment of hypertension. This review highlights the importance of patient in identifying blood pressure targets, and notes that for most individuals without CAD, the target is somewhere below 140/90mmHg. Hopefully, this valuable information will be applied to improve the treatment of hypertension and reduce the risk of cardiovascular events.
Written By: Sonia Parmar, BSc