General cardiology

Should systolic blood pressure goals be lowered?

At all levels, systolic blood pressure exhibits a continuous relationship with the risk of coronary heart disease and stroke. Current hypertension guidelines recommend that systolic blood pressure be maintained at less than 140 mm Hg, but in this study Verdecchia et al tested the hypothesis that tighter control of systolic blood pressure (<130 mm Hg) may be beneficial in patients without diabetes.

In a randomised, open-label trial, 1111 patients with systolic blood pressures greater than 150 mm Hg were randomly assigned to a target systolic pressure of either 140 mm Hg (“usual control”) or 130 mm Hg (“tight control”). The primary endpoint was the rate of electrocardiographic left ventricular hypertrophy 2 years after randomisation, as read by an observer who was blinded to the target blood pressure in each case. The main secondary outcome was a composite of all-cause mortality, fatal or non-fatal myocardial infarction, fatal or non-fatal stroke, transient ischaemic attack, congestive heart failure of New York Heart Association stages III or IV requiring admission to hospital, angina pectoris with objective evidence of myocardial ischaemia, new-onset atrial fibrillation, coronary revascularisation, aortic dissection, occlusive peripheral arterial disease and renal failure requiring dialysis.

Over a mean follow-up of 2.0 years, systolic blood pressure was reduced by a mean of 23.5 mm Hg in the usual control group and 27.3 mm …