What should the target blood pressure goals be?

Arterial stiffness is associated with target organ damage in subjects with pre-hypertension

INTRODUCTION

Present study was to evaluate whether increased arterial stiffness was associated with target organ damage in pre-hypertensive subjects.

MATERIAL AND METHODS

Pre-hypertensive subjects enrolled and echocardiography was used to evaluate left ventricular hypertrophy (LVH) and the first morning urine was collected to evaluate albumin and creatinine ratio (ALB/Cr ratio). Carotid-femoral pulse wave velocity (cf-PWV) was measured.

RESULTS

A total of 420 subjects were recruited and mean age was 42.6 years. Mean systolic/diastolic blood pressure (SBP/DBP) were 130 ±9 mm Hg and 85 ±4 mm Hg. The prevalence of albuminuria and left ventricular hypertrophy was 8.6 % and 11.7 %. Mean cf-PWV was 9.2 ±1.0 m/s, with arterial stiffness prevalence was 8.8%. Subjects with arterial stiffness had higher cf-PWV value (10.6 ±0.4 m/s vs. 8.7 ±0.6 m/s, p < 0.05), and ALB/Cr ratio (28.3 ±13.2 µg/mg vs. 23.1 ± 11.4 µg/mg, p < 0.05). Overall, with multivariate regression analysis, aging and arterial stiffness were significantly associated with pre-hypertension. With stepwise adjusted for potential covariates including age, male gender, fasting plasma glucose, presence of current cigarette smoking, dyslipidemia, statins and SBP, increased cf-PWV remained independently associated with left ventricular hypertrophy and albuminuria, with an increased odds of 41 % and 24 % (p < 0.05), respectively.

CONCLUSIONS

In pre-hypertensive subjects, arterial stiffness is independently associated with LVH and albuminuria and cf-PWV may be a useful marker to identify target organ damage in pre-hypertensive subjects.

Lessons learned from Systolic Blood Pressure Intervention Trial

PURPOSE OF REVIEW

The optimal blood pressure (BP) goal during treatment of hypertension has been controversial. In this report, recent articles that elaborate on this issue are reviewed.

RECENT FINDINGS

Results from the Systolic Blood Pressure Intervention Trial (SPRINT) have suggested substantial benefits from more intensive BP lowering than is recommended in current US BP management guidelines.

SUMMARY

Increasing evidence suggests that intensive BP lowering provides a cost-effective means to improve health in many adults with high BP. SPRINT provides the most convincing confirmation, but experience in other trials, alone and in pooled analyses augments and broadens the evidence base to patient groups who were not included in SPRINT. Implementation trials to document feasibility and effectiveness of SPRINT-like interventions in routine practice, including in resource-constrained settings, are warranted.