Over the past two decades there has been controversy over the appropriate blood pressure goals to be set as the standard, with data suggesting a diminishing benefit of achieving lower and lower numbers with medication, and even some studies suggesting a ‘J’ curve.…meaning that as blood pressure gets lower and lower, the risk profile becomes higher and rather than being a straight line downward, we get a hook to the graph, that goes upward…a ‘J’ that indicates blood pressure has been lowered so much that it is increasing the risk of health issues.
This latest large study is now saying that an extra medication to lower blood pressure further, for instance going from 2…to 3 medications….will provide improved outcomes as regards heart attacks and strokes.
Since this conversation has been going on for decades and is likely to continue to go on for the foreseeable future, what I would focus on is not achieving definitive ‘cookie cutter’ goals for all patients, but would see this data as supporting strong efforts to lower blood pressure in patients who have:
1. Additional health issues like heart disease or stroke or diabetes
2. Are not inclined to take medication to lower their blood pressure enough…we need to push our patients a bit stronger.
3. We still need to get patients to understand that hypertension is truly ‘silent’ and that there is lots of data supporting the use of medications, even multiple medications, to achieve lower blood pressure.
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