Redefining blood pressure targets in high-risk patients: Lessons from coronary endpoints in recent randomized clinical trials

Massimo Volpe, Giuliano Tocci

Research output: Contribution to journalArticlepeer-review


The benefits of lowering blood pressure (BP) in hypertension, as well as in patients with diabetes, chronic renal disease or with a high cardiovascular (CV) risk profile, have been consistently demonstrated. Further clinical trials have explored the influence of BP levels in the lower range on the incidence of CV events, while some others have designed to evaluate the potential benefits obtained with an intensive antihypertensive therapy, aimed at achieving a target systolic BP levels below 120mmHg on major CV events among high-risk individuals with type 2 diabetes, as compared to that obtained from a standard therapy. Taken together, the results of several recent randomized clinical trials (RCTs) have challenged the currently prevailing paradigm the lower, the better in the hypertension management and have somehow revitalized the concept of the J-curve with respect to relations between BP levels and coronary events. In fact, detailed analyses showed an increased risk of coronary events, mostly myocardial infarction, in those patients who achieved the lowest BP levels, particularly in high-risk subsets of hypertensive patients. The same trials, however, confirmed the benefits of BP reductions even below 120mmHg on stroke incidence. In the present article, we revisited the main findings of some recent large clinical trials performed in hypertension and in high-risk individuals. Our conclusions highlight the importance of a closer scrutiny for coronary artery disease and suggest caution in lowering BP levels aggressively in patients with high-risk profile or diabetes.

Original languageEnglish
Pages (from-to)1060-1068
Number of pages9
JournalAmerican Journal of Hypertension
Issue number10
Publication statusPublished - Oct 2011


  • antihypertensive treatment
  • blood pressure
  • blood pressure targets
  • coronary artery disease
  • high blood pressure
  • high cardiovascular risk
  • hypertension
  • J-curve

ASJC Scopus subject areas

  • Internal Medicine


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