IDENTIFYING AN OPTIMAL BLOOD PRESSURE TARGET: DOSE ONE TARGET FIT ALL?

摘要

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed no significant difference in cardiovascular events between a systolic BP target of less than 120 mm Hg vs. less than 140 mm Hg among patients with type 2 diabetes. In contrast, the SPRINT study strongly supports a systolic goal of less than 120 mm Hg for people at high cardiovascular risk, particularly in those aged ≥75 years.The post-hoc analyses of the CSPPT indicated that a BP goal (120–130 mmHg) that is lower than that recommended by the existing guidelines may be associated with a greater reduction in risk of stroke and all-cause mortality in general hypertensive patients (mean age: ~60 years) without history of stroke and myocardial infarction. The beneficial results were consistent across the age (<60 versus ≥ 60 years; <65 versus ≥ 65 years).These findings raise new questions for future research and challenge us to improve BP management. Given that the risk of hypertension and stroke are particularly high in Chinese populations compared to western populations, future research should include diverse populations and important epidemiological and clinical characteristics: race/ethnicity, environment, nutritional status, lifestyle, and co-morbidities. It is expected that this line of research will provide evidence-based guidelines for BP targets that are tailored for specific populations and individuals.