Play Your Cards Right

Here’s an interesting one.

Based on national and local guidelines we aim for a blood pressure level of 140/85 mmHg.

We are a bit more strict in people with diabetes (140/80 mmHg).

The general consensus is that average home blood pressure should be lower than clinic blood pressure (130/80 if no diabetes and 130/75 with diabetes).

There has been pressure from the clever bods up on high to aim for much tighter bp control in people percieved to be at a higher risk of complications from a high blood pressure. For example people with diabetes, chronic kidney disease and established cardiovascular disease.

The logic goes something like this;

1. there is a continuous direct relationship between blood pressure and adverse cardiovascular events

2. the main aim in people with high blood pressure is to decrease their morbidity and mortality

3. lower the blood pressure

4. there is no clearly defined lower threshold of blood pressure which will do more harm than good, therefore see 1.

It was good to learn Arguedas et al have recently performed a Cochrane review.

Treatment blood pressure targets for hypertension

An extensive search was performed to look for randomized controlled trials comparing pateints randomized to standard or lower BP targets and their outcomes.

There were no trials comparing different systolic BP targets found. There were 7 trials comparing different diastolic BP targets. This was a total just over 22,000 people.

Look at the review (link) for the numbers, but essentially attempting to achieve lower targets instead of standard targets did not change;

• total mortality
• myocardial infarction
• stoke
• congestive heart failure
• major cardiovascular events

or

• end-stage renal disease

Aiming for blood pressure targets lower than 140/90 mmHg is not beneficial.