The evidence for two recommendations of all major guidelines on hypertension is critically discussed. The first recommendation is that of initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk, and even when blood pressure is in the high normal range in patients with diabetes and previous cardiovascular disease. The second recommendation is that of achieving systolic blood pressure levels below 140 mmHg in all hypertensive patients, including the elderly, and values below 130 mmHg in patients having diabetes and high/very-high-risk patients. Critical analyses of the results of available trials show that the evidence is scanty for both recommendations. Nonetheless, they can be accepted as prudent statements, as antihypertensive agents are very well tolerated and lowering systolic blood pressure below 130 mmHg appears well tolerated. However, wisdom should not be taken for evidence, and simple trials should be designed to look for more solid evidence in favour of current recommendations. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Zanchetti, A., Grassi, G., Mancia, G. (2009). When should antihypertensive drug treatment be initiated and to what levels ahould systolic blood pressure be lowered? A critical reappraisal. JOURNAL OF HYPERTENSION, 27(5), 923-934 [10.1097/HJH.0b013e32832aa6b5].

When should antihypertensive drug treatment be initiated and to what levels ahould systolic blood pressure be lowered? A critical reappraisal

GRASSI, GUIDO;MANCIA, GIUSEPPE
2009

Abstract

The evidence for two recommendations of all major guidelines on hypertension is critically discussed. The first recommendation is that of initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk, and even when blood pressure is in the high normal range in patients with diabetes and previous cardiovascular disease. The second recommendation is that of achieving systolic blood pressure levels below 140 mmHg in all hypertensive patients, including the elderly, and values below 130 mmHg in patients having diabetes and high/very-high-risk patients. Critical analyses of the results of available trials show that the evidence is scanty for both recommendations. Nonetheless, they can be accepted as prudent statements, as antihypertensive agents are very well tolerated and lowering systolic blood pressure below 130 mmHg appears well tolerated. However, wisdom should not be taken for evidence, and simple trials should be designed to look for more solid evidence in favour of current recommendations. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Articolo in rivista - Articolo scientifico
Drug therapy; Blood Pressure control; Guidelines
English
2009
27
5
923
934
none
Zanchetti, A., Grassi, G., Mancia, G. (2009). When should antihypertensive drug treatment be initiated and to what levels ahould systolic blood pressure be lowered? A critical reappraisal. JOURNAL OF HYPERTENSION, 27(5), 923-934 [10.1097/HJH.0b013e32832aa6b5].
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/10091
Citazioni
  • Scopus 257
  • ???jsp.display-item.citation.isi??? 228
Social impact