Management plans for populations with normal-to-hypertensive blood pressures: risks and benefits of antihypertensive drug treatment in populations previously defined as having high-normal blood pressure

다국어 초록 (Multilingual Abstract)

Recent changes in American and European guidelines on the management of arterial hypertension have caused a considerable shift in the landscape of hypertension management. The 2017 American College of Cardiology/American Heart Association/American Society of Hypertension guideline recommends an office visit blood pressure (BP) > 130/80 mmHg as the new threshold for diagnosis of hypertension, and states that the treatment goal for all hypertensive patients should be lowered to < 130/80 mmHg. In contrast, the 2018 European guideline maintains the diagnostic threshold of hypertension at 140/90 mmHg. However, despite their differences in thresholds for diagnosis of hypertension, both guidelines are in agreement that treatment should be considered in patients with BPs in the range of 130 to 139/80 to 89 mmHg if they have high cardiovascular risk. The results from the Systolic Blood Pressure Intervention Trial (SPRINT) study and recent meta-analyses suggest that BP lowering with antihypertensive treatment may be beneficial in reducing cardiovascular event rates in subjects with high-normal BP or stage 1 hypertension according to the new American guideline. However, intensive BP lowering is associated with increased incidence of treatment-associated adverse events, and evidence suggests that BP lowering below 120/70 mmHg increases the risk of cardiovascular events. In this review, we discuss the evidence supporting antihypertensive treatment in subjects with high-normal BP and discuss the specific subgroup of subjects that might benefit from BP lowering.

참고문헌 (Reference)

1 김희진, "The J-curve between Diastolic Blood Pressure and Risk of All-cause and Cardiovascular Death" 대한심장학회 48 (48): 36-47, 2018

2 Lee M, "Presence of baseline prehypertension and risk of incident stroke : a meta-analysis" 77 : 1330-1337, 2011

3 장신이, "Prehypertension and Left Ventricular Diastolic Dysfunction in Middle-Aged Koreans" 대한심장학회 46 (46): 536-541, 2016

4 Wang S, "Impact of baseline prehypertension on cardiovascular events and all-cause mortality in the general population : a meta-analysis of prospective cohort studies" 168 : 4857-4860, 2013

5 윤남식, "Impact of High-Normal Blood Pressure Measured in Emergency Room on Adverse Cardiac Events in Acute Myocardial Infarction" 대한심장학회 42 (42): 304-310, 2012

6 Khera R, "Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in United States and China:nationally representative cross sectional study" 362 : k2357-, 2018

7 Xie X, "Effects of intensive blood pressure lowering on cardiovascular and renal outcomes : updated systematic review and meta-analysis" 387 : 435-443, 2016

8 Thomopoulos C, "Effects of blood-pressure-lowering treatment on outcome incidence. 12. Effects in individuals with high-normal and normal blood pressure: overview and meta-analyses of randomized trials" 35 : 2150-2160, 2017

9 Thomopoulos C, "Effects of blood pressure lowering treatment in hypertension: 8. Outcome reductions vs. discontinuations because of adverse drug events: meta-analyses of randomized trials" 34 : 1451-1463, 2016

10 Lonn EM, "Blood-pressure lowering in intermediate-risk persons without cardiovascular disease" 374 : 2009-2020, 2016

11 Ettehad D, "Blood pressure lowering for prevention of cardiovascular disease and death : a systematic review and meta-analysis" 387 : 957-967, 2016

12 Filipovsky J, "Automated compared to manual office blood pressure and to home blood pressure in hypertensive patients" 25 : 228-234, 2016

13 Brunstrom M, "Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels : a systematic review and meta-analysis" 178 : 28-36, 2018

14 Guo X, "Association between pre-hypertension and cardiovascular outcomes : a systematic review and meta-analysis of prospective studies" 15 : 703-716, 2013

15 Lewington S, "Age-specific relevance of usual blood pressure to vascular mortality : a meta-analysis of individual data for one million adults in 61prospective studies" 360 : 1903-1913, 2002

16 Bohm M, "Achieved blood pressure and cardiovascular outcomes in high-risk patients : results from ONTARGET and TRANSCEND trials" 389 : 2226-2237, 2017

17 SPRINT Research Group, "A randomized trial of intensive versus standard blood-pressure control" 373 : 2103-2116, 2015

18 Williams B, "2018 ESC/ESH guidelines for the management of arterial hypertension" 39 : 3021-3104, 2018

19 Whelton PK, "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults : executive summary : a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines" 12 : 579.e1-579.e73, 2018