How far should blood pressure be lowered in essential hypertension to optimize the results? A qué niveles bajar la presión arterial en la hipertensión esencial para optimizar el resultado?

Abstract

Early studies of the seventies and eighties showed an inverse relationship between blood pressure reduction and incidence of complications and death. Afterwards, in the late eighties, some authors showed that reductions of diastolic blood pressure beyond 85 or 90 mm Hg increased coronary heart disease mortality (J shaped curve). Meta-analyses and recent epidemiological studies have shown that cardiovascular morbidity decreases along with reductions in diastolic blood pressure, if it is kept within normal limits (70-89 mm Hg). Cardiovascular mortality decreases significantly with blood pressure reductions of 7 to 8 mmHg. Some authors have suggested that diastolic blood pressure should be reduced to 85 mmHg or less in individuals with several cardiovascular risk factors, to obtain a better risk reduction. This hypothesis waits for confirmation from follow-up studies.