According to a new analysis of the ALLHAT trial, blood pressure (BP) targets may need to be adjusted based on the cardiovascular outcome for which the patient has the highest risk.

The results suggested that for a patient with a particular risk of stroke, more aggressive BP lowering may be needed compared to a patient with a particular risk for myocardial infarction (MI).

Researchers used data from the ALLHAT trial of antihypertensive treatment to determine the risk patterns for cardiovascular events and all-cause mortality linked with different systolic and diastolic BP values simultaneously. Over a median follow-up of 4.4 years, 2636 MIs, 866 events of heart failure, 936 strokes, and 3700 deaths were reported. It was noted that for the composite outcome of all-cause mortality, MI, and heart failure, there was a U-shaped association with both systolic and diastolic BP; however, the BPs associated with the lowest hazards were different for each outcome. A pressure of 140-155/70-80 mmHg was found to be linked with the lowest risk of all-cause mortality, compared with 110-120/85-90 mmHg for MI and 125-135/70-75 mmHg for heart failure. The link of both systolic and diastolic BP and stroke was linear, and lower values of both were tied to a lower risk of stroke.   

The findings are published in the Journal of the American College of Cardiology… (Medscape)