Blood Pressure and Cardiovascular Outcomes

The prevalence of hypertension is increasing worldwide in men and women of all ages and in children. Starting in the 1960s, many clinical trials showed evidence of the benefit of treating hypertension. As a result of these trials, organizations such as the NHLBI, AHA, and ACC spearheaded the development of national guidelines to help clinicians manage individuals with hypertension. These guidelines have evolved over time as large double-blind, placebo-controlled trials elicit new information regarding the treatment of hypertension. Treatment goals have become stricter based on the findings of trials such as SPRINT. Clinical trials regarding treatment of high-risk populations with co-morbid conditions such as diabetes or chronic kidney disease (AASK, ACCORD, and SPRINT) suggested that certain populations require more intensive treatment goals. Using proper techniques for measuring blood pressure (BP) is of critical importance. Home BP measurement and 24-hour ambulatory BP monitoring are generally more accurate than measurements obtained in a clinical setting. The field is moving toward utilizing cardiovascular risk stratification of patients in setting goals for treatment of hypertension.