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01.11.2018 | Hypertension (DS Geller and DL Cohen, Section Editors) | Ausgabe 11/2018

Current Cardiology Reports 11/2018

Dangers of Overly Aggressive Blood Pressure Control

Current Cardiology Reports > Ausgabe 11/2018
Faisal Rahman, John W. McEvoy
Wichtige Hinweise
This article is part of the Topical Collection on Hypertension


Purpose of Review

Recent US guidelines have changed the definition of hypertension to ≥ 130/80 mmHg and recommended more intense blood pressure (BP) targets. We summarize the evidence for intense BP treatment and discuss risks that must be considered when choosing treatment goals for individual patients.

Recent Findings

The SPRINT study reported that treating to a systolic BP target of 120 mmHg reduces cardiovascular outcomes in high-risk individuals, supporting more intensive BP reduction than previously recommended. However, recent observational studies have placed emphasis on the BP J-curve phenomenon, where low BPs are associated with adverse cardiovascular outcomes, suggesting that overly aggressive BP targets may sometimes be harmful. We attempt to reconcile these apparent contradictions for the clinician. We also review other potential dangers of aggressive BP targets, including syncope, renal impairment, polypharmacy, drug interactions, subjective drug side-effects, and non-adherence.


We suggest a personalized approach to BP drug management considering individual risks, benefits, and preferences when choosing therapeutic targets, recognizing that a goal of 130/80 mmHg should always be considered. Additionally, we recommend an intense focus on lifestyle changes and medication adherence.

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