Editorial

Optimal Blood Pressure Control in High-Risk Groups: Are the Guidelines Letting Us Down?

Authors: Kim A. Connelly, MD, PhD, Darren Yuen, MD

Abstract

The association between hypertension and cardiovascular disease is beyond dispute.1 A continuum of cardiovascular risk exists across blood pressure (BP) strata, commencing around 115/75.2 Despite this, data provided by the National Health and Nutrition Examination Survey (NHANES) demonstrates less-than-optimal blood pressure control, with only 54% of the 65 million Americans with hypertension meeting guideline targets.3 Whilst optimal blood pressure control in 100% of affected individuals remains the goal, data from large scale, rigourously controlled clinical trials, where regular patient review coupled with evidence-based protocols for blood pressure management, results in optimal BP control in only 70%. The above data pertain to those patients where acceptable BP control is defined as a systolic BP <140 mm Hg and a diastolic BP less than 90 mm Hg.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. Arch Intern Med 1993;153:598–615.
 
2.Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality:a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903–1913.
 
3.Fields LE, Burt VL, Cutler JA, et al. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension 2004;44:398–404.
 
4.Rosendorff C. Hypertension and coronary artery disease: a summary of the american heart association scientific statement. J Clin Hypertens (Greenwich) 2007;9:790–795.
 
5.Basile J. Rationale for fixed-dose combination therapy to lower blood pressure goals. South Med J 2008;101:918–924.
 
6.Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001;345:1291–1297.
 
7.Berl T, Hunsicker LG, Lewis JB, et al. Impact of achieved blood pressure on cardiovascular outcomes in the Irbesartan Diabetic Nephropathy Trial. J Am Soc Nephrol 2005;16:2170–2179.
 
8.Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998;351:1755–1762.
 
9.Boutitie F, Gueyffier F, Pocock S, et al. J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med 2002;136:438–448.
 
10.Schwarz UI, Ritchie MD, Bradford Y, et al. Genetic determinants of response to warfarin during initial anticoagulation. N Engl J Med 2008;358:999–1008.