European hypertension BP target relaxed for high-risk patients

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New European hypertension guidelines recommend treating all patients to a target systolic blood pressure level of below 140 mmHg, regardless of their cardiovascular risk, after experts decided that latest evidence does not support the previously recommended goal of less than 130 mmHg for high-risk patients.

The study

Experts from the European Society of Cardiology and European Society of Hypertension reviewed the evidence from randomised controlled trials regarding clinical outcomes when blood pressure is lowered to below 130/80 mmHg compared with below 140/90 mmHg.

The findings

There was no consistent evidence that achieving systolic blood pressure levels below 130 mmHg reduces cardiovascular events compared with below 140 mmHg in patients with diabetes or a history of cardiovascular or renal disease.Nor did the findings support treating to below 80 mmHg diastolic blood pressure.

However, there was evidence that lowering diastolic blood pressure below 85 mmHg is beneficial for patients with diabetes, and the guidelines authors emphasise that diastolic levels of between 80 mmHg and 85 mmHg are ‘safe and well tolerated’ in all patients.

For elderly people up the age of 80 years, the evidence supports treating to 140–150 mmHg systolic blood pressure, or below 140 mmHg in particularly fit individuals. Those over 80 years also benefit from treatment to 140–150 mmHg provided they are in good mental and physical health.

What this means for GPs

The introduction of single, unified blood pressure target brings the European guidance more closely in line with current UK guidelines and provides further evidence that intensive blood pressure lowering in ‘high-risk’ patients is not beneficial.

‘There was not enough evidence to justify two targets,’ said Professor Robert Fagard, from Leuven University, Belgium, who co-chaired the writing committee.

Eur Heart J 2013; available online 14 June

G Mohan.