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July 2017

New Blood Pressure–Lowering Targets—Finding Clarity

Author Affiliations
  • 1Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 2Deputy Editor, JAMA Cardiology
  • 3Editor, JAMA Cardiology
JAMA Cardiol. 2017;2(7):719-720. doi:10.1001/jamacardio.2017.1422

Over several decades, we have seen definitions of “normal” blood pressure change and have wrestled with treatment targets. Arguments of harm have emerged regarding the existence of a “J-curve” phenomenon, and concerns are recognized addressing the potential risk of aggressive treatment targets in diabetic patients with hypertension. These arguments have been fueled by findings from well-done randomized clinical trials with many varied inclusion and exclusion criteria and heterogeneous patient cohorts. The findings, when codified, have informed clinical practice guidelines. These many varied results have yielded an array of treatment recommendations for clinical practice1-5 (Table). As a consequence, there is poor consensus and worrisome uncertainty in the practice community regarding ideal targets for one of the most important risk factors for cardiovascular disease (CVD). This is one scenario for which a well-executed meta-analysis might be immensely valuable.

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