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HYPERTENSION

Are blood-pressure targets needed to prevent cardiovascular disease?

Nature Reviews Cardiology volume 18, pages 615–616 (2021)Cite this article

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Mounting evidence from the SPRINT trial and the Blood Pressure Lowering Treatment Trialists points towards the use of absolute cardiovascular risk assessment to guide blood-pressure management. But who will fall between the cracks? We need to be pragmatic in keeping blood-pressure targets, if only to serve the >1 billion people at risk of cardiovascular disease living in low-resource settings.

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Fig. 1: Intraindividual blood-pressure variability.

References

  1. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 1223–1249 (2020).

    Article  Google Scholar 

  2. The SPRINT Research Group. Final report of a trial of intensive versus standard blood-pressure control. N. Engl. J. Med. 384, 1921–1930 (2021).

    Article  Google Scholar 

  3. The Blood Pressure Lowering Treatment Trialists’ Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 397, 1625–1636 (2021).

    Article  Google Scholar 

  4. Kallioinen, N., Hill, A., Horswill, M. S., Ward, H. E. & Watson, M. O. Sources of inaccuracy in the measurement of adult patients’ resting blood pressure in clinical settings: a systematic review. J. Hypertens. 35, 421–441 (2017).

    Article  CAS  Google Scholar 

  5. Fatani, N., Dixon, D. L., Van Tassell, B. W., Fanikos, J. & Buckley, L. F. Systolic blood pressure time in target range and cardiovascular outcomes in patients with hypertension. J. Am. Coll. Cardiol. 77, 1290–1299 (2021).

    Article  Google Scholar 

  6. Li, Y. et al. Opposing age-related trends in absolute and relative risk of adverse health outcomes associated with out-of-office blood pressure. Hypertension 74, 1333–1342 (2019).

    Article  CAS  Google Scholar 

  7. Olsen, M. H. et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet 388, 2665–2712 (2016).

    Article  Google Scholar 

  8. Mills, K. T., Stefanescu, A. & He, J. The global epidemiology of hypertension. Nat. Rev. Nephrol. 16, 223–237 (2020).

    Article  CAS  Google Scholar 

  9. Chapman, N. et al. General practitioners maintain a focus on blood pressure management rather than absolute cardiovascular disease risk management. J. Eval. Clin. Pract. https://doi.org/10.1111/jep.13569 (2021).

    Article  PubMed  Google Scholar 

  10. Rea, F., Corrao, G., Merlino, L. & Mancia, G. Initial antihypertensive treatment strategies and therapeutic inertia. Hypertension 72, 846–853 (2018).

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The author thanks Josep Sola (Aktiia, Neuchâtel, Switzerland) for providing the 24/7 cuff-less blood-pressure data for Figure 1.

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Authors and Affiliations

  1. School of Population Health, University of New South Wales, Sydney, New South Wales, Australia

    Aletta E. Schutte

  2. The George Institute for Global Health, Sydney, New South Wales, Australia

    Aletta E. Schutte

  3. Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa

    Aletta E. Schutte

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  1. Aletta E. Schutte
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Correspondence to Aletta E. Schutte.

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Competing interests

A.E.S. is senior author of the 2020 International Society of Hypertension Practice Guidelines and an advisory board member for Aktiia (Neuchâtel, Switzerland) cuff-less blood-pressure devices.

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Schutte, A.E. Are blood-pressure targets needed to prevent cardiovascular disease?. Nat Rev Cardiol 18, 615–616 (2021). https://doi.org/10.1038/s41569-021-00595-4

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