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The global burden of hypertension exceeds 1.4 billion people

should a systolic blood pressure target below 130 become the universal standard?

Egan, Brent M.a; Kjeldsen, Sverre E.b; Grassi, Guidoc,d; Esler, Murraye; Mancia, Guiseppef

doi: 10.1097/HJH.0000000000002021
Review: PDF Only

In 2010, 1.4 billion people globally had hypertension, with 14% controlled to systolic blood pressure (SBP, mmHg) below 140, which contributes to 18 million cardiovascular deaths annually. Recent hypertension guidelines endorsed SBP targets below 130 or lower for all or some hypertensive patients to reduce cardiovascular events (CVEs) more than the prior SBP target less than 140. In 2016, the Australian Guideline strongly recommended target SBP below 120 for adults at very high risk for CVE or aged above 75 years. In 2017 and 2018, the Canadian Guideline recommended automated office SBP (AOSBP) below 120 in adults at high risk and aged above 75 years (grade B). In 2017, the US Guideline recommended SBP below 130 for all adults (moderate-to-high risk class I; lower-risk grade IIb). In 2018, the European Guideline recommended SBP below 140 for all adults, and, if tolerated, a SBP range of 120–129 for adults aged below 65 years and 130–139 for adults aged at least 65 years (class I). The guidelines were variably influenced by Systolic blood PRessure INTervention trial and meta-analyses indicating fewer CVE when mean in-trial SBP was below 130 versus above 130. Clinicians considering lower SBP targets should be aware that: AOSBP preceded by 5-min rest is approximately 10–15 mmHg lower than usual office SBP; hypertensive patients with office SBP consistently versus intermittently below 140 have fewer CVE; benefits of mean office SBP or AOSBP below 120 remain unproven and could increase adverse events. Clinicians worldwide will do well to control SBP to below 140 in most hypertensive patients on most visits, which should lead to mean in-clinic SBP of 120–129.

aUniversity of South Carolina School of Medicine–Greenville, Care Coordination Institute and Greenville Health System, Greenville, South Carolina, USA

bDepartment of Cardiology, Oslo University, Hospital Ullevaal, Oslo, Norway

cClinica Medica, Departments of Medicine and Surgery, University Milano-Biocca

dRCCS Multimedica, Sesto San Giovanni, Milan, Italy

eBaker IDI Heart and Diabetes Institute, University of Melbourne, Alfred Hospital, Melbourne, Australia

fDepartment of Internal Medicine, University of Milano-Bicocca, Hospital Monza/Milano, Milan, Italy

Correspondence to Brent M. Egan, MD, Care Coordination Institute, 300 East McBee Avenue, Greenville, SC 29601, USA. Tel: +1 864 522 2260; fax: +1 864 522 2275; e-mail:

Received 25 September, 2018

Accepted 14 November, 2018

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