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How We Got Where We Are in Blood Pressure Targets

  • Guidelines / Clinical Trials/Meta-Analysis (WJ Kostis, Section Editor)
  • Published:
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Abstract

Purpose of Review

While we started clinical trials evaluating the benefit of lowering systolic BP’s >160 mm Hg and diastolic BPs of <130 mm Hg, the latest guideline suggests a target of <130/80 mm Hg in those with hypertension. This article summarizes exactly how we got to where we are looking over the last half-century.

Recent Findings

Our understanding of systolic and diastolic blood pressure targets to improve cardiovascular outcomes has changed substantially over the past 5 decades. Regarding diastolic blood pressure targets to improve cardiovascular outcomes, initially the VA1 in 1967 had set the goal to <115 mmHg. Over time, several studies including the VA2, Hypertension Optimal Treatment (HOT), and United Kingdom Prospective Diabetes Study Group 38 (UKPDS38) highlighted even greater cardiovascular benefit with lower diastolic targets <80 mmHg, especially in diabetic patients. Of equal importance, multiple studies have focused the attention to systolic blood pressure targets. Starting in 1948 with the Framingham study, passing through the Systolic Hypertension in the Elderly Program (SHEP), Syst-Eur and Syst-China trials, all have set the systolic blood pressure goal <150 mmHg. Most recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed an improved cardiovascular outcome with a systolic blood pressure target <140 mmHg in patients with type 2 diabetes, while the Systolic Blood Pressure Intervention Trial (SPRINT) in non-diabetic patients moved it closer to 120 mmHg.

Summary

There is “no one size fits all” when it comes to blood pressure targets to improve cardiovascular outcomes. To progress our understanding of individual blood pressure goals, future studies might develop a more standardized approach to highlight characteristics such as design and end point definitions while allowing clinical practitioners greater latitude to adapt guideline recommendations to individual patient characteristics and clinical needs.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgements

Drs. Herbeth, Fülöp and Basile are current employee of the United States Department of Veteran Health Administrations. However, the views and opinions expressed herewith do not reflect the official views or opinion or endorsed by the United States Veteran Health Administrations.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425, USA

    Johann Herberth, Karim M. Soliman & Tibor Fülöp

  2. Medicine Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA

    Johann Herberth, Tibor Fülöp & Jan N. Basile

  3. Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA

    Jan N. Basile

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  1. Johann Herberth
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  2. Karim M. Soliman
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Correspondence to Karim M. Soliman.

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Herberth, J., Soliman, K.M., Fülöp, T. et al. How We Got Where We Are in Blood Pressure Targets. Curr Hypertens Rep 23, 33 (2021). https://doi.org/10.1007/s11906-021-01143-8

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