The therapeutic blood pressure (BP) targets to be attained have long been a topic of debate. Several clinical studies and meta-analyses, especially the SPRINT trial, have shown the advantages of intensive antihypertensive treatment in reducing major cardiovascular events, myocardial infarction, stroke, heart failure, and all-causes cardiovascular mortality.

These trials were followed by several international Guidelines recommending BP target of <130/80mmHg for a majority of hypertensive patients till 65 years of age. The guidelines also suggested a reduction of the target for the elderly.

The 2017 American College of Cardiology/American Heart Association (ACC/ AHA) guidelines as well as the European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines identified the new therapeutic goal of 130/80mmHg for all hypertensive patients 18-65years of age, or lower, if well-tolerated.

Additionally, initiating antihypertensive treatment early helps achieve the recommended BP targets faster, and is also associated with significant benefits in terms of reduction of the incidence of myocardial infarction, heart failure, and major cardiovascular events, especially when BP control is achieved during the first 6 months of treatment. The outcome is even better if BP control is achieved during first 3 months of treatment.

Furthermore, there have been studies showing that combination therapy, particularly a single-pill combination, is better at attaining the recommended therapeutic levels. The ESC/ESH 2018 guidelines strongly support the use of combination therapy in the management of hypertension, particularly the use of renin–angiotensin–aldosterone system inhibitors in combination with calcium antagonist and/or thiazide diuretics.

The revised therapeutic goals have particular significance for high-risk patients, such as those with previous cardiovascular events, diabetes mellitus, renal insufficiency, and patients above 65.

Intensive antihypertensive treatment with a therapeutic goal of 130/80mmHg is highly beneficial in reducing major cardiovascular events as well as mortality. Early initiation of antihypertensive treatment as well as the use of single-pill combination therapy is of particular significance in realizing the therapeutic goals.      

Source: Volpe M, Gallo G. To whom recommend intensive treatment for hypertension? European Heart Journal Supplements 2020;22 (Supplement E):E167–E172.