scholarly journals Blood Pressure and Global Risk Assessment in a Swedish Population

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Jenny Eckner ◽  
Charlotte A. Larsson ◽  
Lennart Råstam ◽  
Ulf Lindblad
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Participation Rate ◽  
Global Risk ◽  
Swedish Population ◽  
Additional Risk ◽  
Global Risk Assessment ◽  
Esc Guidelines ◽  
Blood Pressure Goals ◽  
Optimal Blood Pressure

This study investigated the association between SCORE and the 2007 ESH-ESC blood pressure categories and explored achievements of blood pressure goals considering global risk. In 2001–2005, a random sample of inhabitants aged 30–74 years in southwestern Sweden was invited to a survey of cardiovascular risk factors. The study enrolled 2816 participants (participation rate 76%). Blood pressure was categorized according to the 2007 ESH-ESC guidelines. Global risk of 10-year CVD death was estimated using the Swedish SCORE chart also accounting for additional risk from diabetes (SCORE-DM). SCORE-DM increased in both sexes from optimal blood pressure to manifest hypertension but did not differ between the normal blood pressure categories. However, SCORE-DM became significantly higher among those with temporarily high blood pressure (men 3.3 SD (1.7), women 1.1 (1.8)) and hypertension (3.6 (2.0), 2.0 (2.0)), compared to optimal blood pressure (1.6 (2.9), 0.6 (1.9)). In the presence of both hypertension and diabetes, high-risk subjects dominated (men 76%, women 61%), and correspondingly a major proportion of patients with known hypertension were at high risk at a blood pressure  mm Hg. These findings have strong implications on blood pressure evaluation in clinical practice and support the use of SCORE to evaluate global risk.

scholarly journals Aggressive blood pressure reduction in patients at high vascular risk: is it dangerous?

2012 ◽  
Author(s):  
Fabio Angeli ◽  
Gianpaolo Reboldi ◽  
Cristina Poltronieri ◽  
Giovanni Mazzotta ◽  
Marta Garofoli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Reduction ◽  
Pressure Reduction ◽  
Vascular Risk ◽  
Current State ◽  
J Curve ◽  
Blood Pressure Goals ◽  
Optimal Blood Pressure ◽  
Meta Analyses ◽  
Post Hoc

Introduction The aim of this review was to summarize the current state of evidence regarding the optimal blood pressure goals in patients with high vascular risk. In particular, this review critically addresses the issue of the “J-curve” paradox – a hypothesis indicating that low treatment-induced blood pressure values are characterized by an increase, rather than a decrease, in the incidence of cardiovascular events. Materials and methods We reviewed evidence from studies published in peer-reviewed journals indexed in Medline, EMBASE and CINAHL that compared different BP goals. Results Post-hoc analyses of randomized trials specifically conducted to test the hypothesis of the “J-shaped curve” yielded conflicting results. However, trials directly comparing different blood pressure goals and meta-analyses showed that in-treatment blood pressure values below the usual goal of less than 140/90 mmHg improve outcomes in patients at increased vascular risk. Discussion The fear that an excessive reduction in blood pressure may be dangerous is inconsistent with the available data and probably conditioned by the adverse impact of other risk factors that may be more frequent in patients with low values of achieved blood pressure. The association between blood pressure reduction and cardiovascular risk seems to be linear and not J-shaped.

Developments in Strategies for Treating High-risk Hypertension

2009 ◽  
Vol 5 (1) ◽  
pp. 56
Author(s):  
Cristina Sierra ◽  
Antonio Coca ◽  
◽  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Antihypertensive Drugs ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Current Evidence ◽  
Global Risk ◽  
Raas Blockade

On the basis of current evidence provided by various studies, the most recent international guidelines recommend reducing blood pressure levels to below 140/90mmHg for all hypertensive patients over 18 years of age, including the elderly, when this is clinically tolerated, as a necessary measure to reduce the global cardiovascular risk, which is the fundamental objective of treatment. For high-risk hypertensives, such as patients with diabetes, patients with silent target organ damage or established clinical cardiovascular disease, levels below 130/80mmHg should be reached and maintained, with even lower levels for patients with established renal disease and proteinuria within the nephrotic range. Blood pressure control in high-risk patients should be achieved as rapidly as possible using initial strategies that include combinations of antihypertensive drugs, and also the best drugs and drug combinations with proven capacity to regress silent organ damage and to interrupt the progression of cardiovascular disease. This must be accompanied by the additional lifestyle measures and drugs necessary to control other associated cardiovascular risk factors. In clinical practice this means that, together with renin–angiotensin–aldosterone system (RAAS) blockade, often associated with calcium-channel blockade, statins and antiplatelet drugs should routinely be administered in most patients, particularly those over 55 years of age, as they provide the only possibility of global risk prevention leading to greater survival.

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