Aggressive lowering of blood pressure.

摘要

Aggressive lowering of blood pressure is being advocated by guidelines for controlling hypertension.For decades, clinicians focused on lowering diastolic blood pressure notwithstanding observational data, which emphasised the greater importance of systolic blood pressure in mediating cardiovascular disease risk. An unjustifiable early fear was that antihypertensive treatment of isolated systolic hypertension in elderly people would produce intolerable side-effects, and could be dangerous. Discounting these fears and faced with accumulating epidemiological evidence that isolated systolic hypertension was not an innocuous accompaniment of ageing, investigators started randomised trials in the USA and elsewhere to determine the efficacy of treating isolated systolic hypertension for the prevention of stroke in elderly people.These trials showed the feasibility, safety, and efficacy of lowering systolic blood pressure at all ages and in both sexes. Although there is consensus that elevated systolic blood pressure is harmful and can be safely lowered by treatment, guidelines have differed about thresholds for starting treatment and the goals of treatment, so that the benefits accrued from treatment are commensurate with absolute cardiovascular disease risk in patients.