Evidence-Based Blood Pressure Goals
The recommendation to further reduce blood pressure in patients with renal insufficiency or diabetes is not evidence-based: for renal insufficiency, there is no evidence of benefit for having target values <140/90 mm Hg (1); for diabetes mellitus, it can even be harmful (2). Lowering diastolic blood pressure <80–70 mm Hg for people over 65 is not only not evidence-based—this recommendation seems downright dangerous for older people. It remains completely incomprehensible why the recommendations of the German College of General Practitioners and Family Physicians’ (DEGAM) S3 Guideline on Cardiovascular Prevention of 2017 (3), which is valid in Germany, was not mentioned in the article (4). In the Guideline, an unanimous consensus was reached for the following recommendations (as well as for others):
- The primary goal of antihypertensive treatment is to reduce the overall cardiovascular risk. In general, the target blood pressure should be ≤140 mm Hg systolic and ≤90 mm Hg diastolic.
- For persons over 80, the decision to start or stop therapy should be made on a case-by-case basis.
The primary selection of antihypertensives should be based on efficacy, tolerability, comorbidities, and cost.
Dr. med. Günther Egidi
Primary care physician, Bremen, Germany; firstname.lastname@example.org
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Brunström M, Carlberg B: Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses BMJ 2016; 352: i717 CrossRef|
|2.||Tsai WC, Wu HY, Peng YS, et al.: Association of intensive blood pressure control and kidney disease progression in nondiabetic patients with chronic kidney disease. A systematic review and metaanalysis. JAMA Intern Med 2017; 177: 792–9 CrossRef MEDLINE PubMed Central|
|3.||DEGAM-S3-Leitlinie: Hausärztliche Risikoberatung zur kardiovaskulären Prävention. www.awmf.org/leitlinien/detail/ll/053–024.html (last accessed on 2 September 2018).|
|4.||Jordan J, Kurschat C, Reuter H: Arterial hypertension—diagnosis and treatment. Dtsch Arztebl Int 2018; 115: 557–68 VOLLTEXT|