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Commentary |

What Is Goal Blood Pressure for the Treatment of Hypertension?

Norman M. Kaplan, MD
Arch Intern Med. 2001;161(12):1480-1482. doi:10.1001/archinte.161.12.1480.
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UNCERTAINTY exists as to the appropriate goal of antihypertensive therapy that will provide maximal protection for the majority of patients. In particular, recently published data show an increase in cardiovascular events in elderly patients with isolated systolic hypertension whose diastolic levels were inadvertently lowered to below 65 mm Hg by therapy. Whether such a J-curve exists for those with combined systolic and diastolic hypertension is less certain.

Whereas the goal of 140/90 mm Hg seems appropriate for relatively low-risk hypertensive patients, more intensive therapy to reach a goal below 130/80 mm Hg is indicated for those with high-risk hypertension, including those with diabetes or renal insufficiency. Caution is needed if diastolic levels go below 65 mm Hg in those with isolated systolic hypertension.

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Association between diastolic blood pressure and risk of first-ever stroke for those who used antihypertensive drugs (A) and those who did not (B). The reference category is the second lowest category of diastolic blood pressure. Values are plotted on a logarithmic scale. Relative risk is adjusted for age, sex, smoking habit, diabetes mellitus, ankle-to-arm index, minor vascular events (intermittent claudication, angina pectoris, and history of coronary revascularization procedures), myocardial infarction, atrial fibrillation, and typical and atypical transient ischemic attack. Reproduced with permission from Vokó et al.5

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