Hypertension (HT) is the most important risk factor for cardiovascular diseases (CVD). Effective control of systolic blood pressure (BP) is associated with significant reduction in the incidence of these complications, however, there have been great debates in the past few years on the BP targets. The 2013 European Society of Hypertension and European Society of Cardiology (ESC) HT guidelines suggested a unified systolic BP target of 140 mmHg for both high-risk and low-risk patients. The 2014 Joint National Committee (JNC) report further raised the systolic BP targets to 150 mmHg for those aged ≥ 60 years, including patients with stroke or coronary heart disease (CHD), and raised the systolic BP target to 140 mmHg for diabetes. Instead, the 2015 Hypertension Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS) suggested more aggressive BP targets of < 130/80 mmHg for patients with diabetes, CHD, chronic kidney disease (CKD) with proteinuria, and atrial fibrillation patients on antithrombotic therapy. Based on the main findings from the Systolic Blood Pressure Intervention Trial (SPRINT) and several recent meta-analyses, the HT committee members of the TSOC and THS convened and finalized the revised BP targets for management of HT. We suggested a new systolic BP target to < 120 mmHg for patients with CHD, CKD with an eGFR of 20-60 ml/min/1.73 m2, and elderly patients aged ≥ 75 years, using unattended automated office BP measurement. When traditional office BP measurement is applied, we suggested BP target of < 140/90 mmHg for elderly patients with an age ≥ 75 years. Other BP targets with traditional office BP measurement remain unchanged.
The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline advocates the use of out-of-office BP measurements to confirm HT and evaluate the efficacy of BP-lowering medications. However, the guidelines lower thresholds to define HT than previous guidelines, and are expected to significantly increase the prevalence of patients with HT and identify greater numbers of patients who will ultimately experience adverse cardiovascular events. In the US real world data, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of HT in comparison with the JNC7 guideline, a small increase in the percentage of U.S. adults recommended for antihypertensive medication, and more intensive BP lowering for many adults taking antihypertensive medication; however, little is known about the impact of these guideline changes in patients with or at high risk for CVD．
In this talk, we will review the supporting data and provide a summary of the new recommendations in using individualizing BP targets for people with HT in different clinical scenarios. |
