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Facts and fallacies of blood pressure control in recent trials: implications in the management of patients with hypertension

Zanchetti, Albertoa; Mancia, Giuseppeb; Black, Henry Rc; Oparil, Suzanned; Waeber, Bernarde; Schmieder, Roland Ef; Bakris, George Lg; Messerli, Franz Hh; Kjeldsen, Sverre Ei; Ruilope, Luis Mj

doi: 10.1097/HJH.0b013e3283298ea2

A large body of clinical trial data indicates that a given difference in blood pressure (BP), as measured in the clinic, results in a given difference in outcome. This correlation underpins current US and European guidelines for the management of hypertension. However, findings from recent comparative trials may appear inconsistent with a fixed relationship between BP lowering and outcome benefit, at least at all BP ranges, at all levels of total cardiovascular risk and with all drug combinations. We review the findings of six of these recent trials and conclude that their complex design precludes a simple interpretation, that several important questions remain unanswered and that direct evidence – particularly in support of lowering systolic BP below 140 or 130 mmHg – is urgently needed.

aCentro di Fisiologia Clinica e Ipertensione, University of Milan and Istituto Auxologico Italiano, Milan, Italy

bClinica Medica, University of Milano Bicocca Ospedale San Gerardo, Monza, Italy

cNew York University School of Medicine, New York, New York, USA

dDepartment of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

eDivision of Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

fDepartment of Nephrology and Hypertension, University Hospital, Erlangen, Germany

gUniversity of Chicago, Pritzker School of Medicine, Chicago, Illinois

hSt. Luke's-Roosevelt Hospital Center, New York, New York, USA

iDepartment of Internal Medicine, Ullevaal University Hospital, Oslo, Norway

jHypertension Unit, Hospital 12 de Octubre, Madrid, Spain

Received 27 December, 2008

Revised 21 January, 2009

Accepted 22 January, 2009

Correspondence to Professor Alberto Zanchetti, Centro di Fisiologia Clinica e Ipertensione, University of Milan, Ospedale Maggiore, Via F. Sforza 35, 20122 Milan, Italy

© 2009 Lippincott Williams & Wilkins, Inc.