How low should you go to get your blood pressure normal, and when should you stop? Let's take a look at the current guidelines for blood pressure objectives before seeing where the new study leads us.

Blood pressure management inquiries are incredibly crucial, but there wasn't much information to support your choice up until lately. You may now use an updated Cochrane Review to assist you choose your blood pressure target (Saiz et al. 2022), in order to lower the risk of future complications.

ACC views on hypertension

Some physicians in the US and Europe believe that the present blood pressure standards are set excessively high, according to a significant study released by the American College of Cardiology and the American Heart Association a few years ago (Whelton et al., 2017). Therefore, medical professionals believed that many individuals would benefit from having blood pressure levels that are lower than they already are.

Although there has been some debate on the subject, it is generally accepted that people with the lowest blood pressure are at the lowest risk (Rapsomaniki et al., 2014). As a result, aiming for lower blood pressure makes sense. This is because large studies in various populations have shown that the risk of heart disease and stroke rises steadily as blood pressure increases.

Does all of that thus apply to those who are on blood pressure medication and have a history of cardiovascular disease? The US recommendations, which assume that it does, advise that blood pressure be maintained below 130/80. Doctors and patients alike started to question how the objectives could be met as a result of this new direction (2022), which created confusion.

Many patients require greater dosages or additional medicine to lower their blood pressure below the new goal since they currently use two or more medications to manage it. People may wish to weigh the advantages of reducing cardiovascular disease against the negative effects of pharmaceuticals to balance the greater risk of side effects that comes with taking more medications.

Lower blood pressure goals in European guidelines?

Having previously suggested significantly higher aims than the United States, European recommendations (2021) have recently become much more aggressive. While acknowledging that many people can achieve systolic blood pressure of less than 120mmHg without experiencing negative consequences, the Europeans go further, stating that blood pressure reduction efforts should still be made in people under the age of 66.

What is the UK's guidance like?

The National Institute for Health and Care Excellence (NICE) has revised its recommendation (2022), which is succinctly represented in the graphic overview. The majority of individuals in the UK now take their blood pressure at home, perhaps as a consequence of the COVID epidemic, and NICE has set the goal for home blood pressure at 135/85, making it somewhat higher than in Europe and the USA.

After all that, where do we stand?

This useful Cochrane Review, updated in November 2022, explicitly examines whether cardiovascular disease patients who meet reduced blood pressure goals have a decreased chance of dying. The lower target blood pressure in this study was established at 135/85. The study went on to evaluate the likelihood of unfavourable consequences from blood pressure medication by counting the number of participants who discontinued trials due to adverse drug reactions.

So yet, there is no Cochrane data to support the US and EU's recommendation to strive for lower blood pressure. However, several studies are ongoing that will provide us with more specific knowledge on this crucial matter.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.