Optimal blood pressure: how low should we go?

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines hypertension as systolic blood pressure ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg. Evidence shows that even slightly elevated blood pressure significantly increases the risk of morbidity and mortality and only aggressive efforts to reduce blood pressure can significantly reduce this risk. In the recently completed Hypertension Optimal Treatment trial, patients were assigned to one of three target blood pressure groups, reflecting DBP goals of ≤90, ≤85, and ≤80 mm Hg. Aggressive antihypertensive treatment allowed more than 90% of patients to achieve goal DBP of ≤90 mm Hg. This study clearly showed that these defined goals could be safely met and even exceeded. Too few patients with hypertension receive the level of effective treatment achieved in clinical trials. Individuals with poorly controlled blood pressure are at significant risk for cardiovascular and cerebrovascular morbidity and mortality and represent a potentially substantial burden to the healthcare system. Setting appropriate blood pressure goals and working to meet them through aggressive antihypertensive treatment, with multiple agents if necessary, can reduce those risks.