Vnitr Lek 2009, 55(9):833-840

Target values in hypertension treatment. Will they apply in older patients with hypertension, diabetics and in patients with IHD?

J. Widimský

Klinika kardiologie IKEM Praha, přednosta prof. MUDr. Jan Kautzner, CSc., FESC

The incidence of isolated systolic hypertension increases with age since 50 years. Systolic pressure appears to have higher prognostic importance than diastolic pressure in patients older than 50 years. Treatment of isolated systolic hypertension importantly decreases cerebrovascular events, coronary events as well as overall mortality. Studies providing the relevant evidence have mostly been conducted at the beginning of 1990s. The baseline systolic pressure in all these studies was 160 mmHg and higher. This is because the isolated systolic hypertension then was defined as systolic pressure of 160 mmHg or higher and diastolic hypertension as pressure of 95 mmHg or higher. No study confirming that systolic pressure lowering to the range of 140-159 mmHg in older patients would positively affect morbidity and mortality, with a further aim to achieve systolic pressure levels of less than 140 mmHg, have been conducted so far. The recommendation to aim, even in older patients, for the target values of less than140 mmHg is based mainly on observational studies. Possible existence of the diastolic pressure J-curve in patients with ischemic heart disease represents another unresolved issue. There is a lack of randomised studies on this subject comparing reduction of the diastolic pressure to below 80, below 70 mmHg and below 60 mmHg. The joint guidelines of the European Society of Hypertension and European Society of Cardiology recommend the target value of

Keywords: BP target values; systolic and diastolic pressure J-curve

Received: July 24, 2009; Published: September 1, 2009  Show citation