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Hypertension is the most common cardiovascular disease in mainland China, according to 2018 data, the prevalence of hypertension in adults over 18 years old in mainland China is as high as 27.5%, about 1 in every 4 adults, and the control rate of blood pressure is very low, only 11%[1].
Hypertension is one of the most important risk factors for cardiovascular diseases, which is easy to cause damage to target organs such as heart, brain and kidney, and actively control blood pressure to meet the standards, which is an important measure for the prevention and treatment of cardiovascular diseases.
How low is the blood pressure target?
140/90mmHg is a well-known antihypertensive target, but recent studies suggest that a lower blood pressure target may be better.
To this end, the Hypertension Group of the Cardiovascular Disease Branch of the Chinese Medical Association recently issued the "Chinese Expert Recommendations for Strengthening Blood Pressure Control" (hereinafter referred to as the "Recommendations") [2]. The recommendation states that a more aggressive and rigorous blood pressure management strategy should be adopted to mitigate target organ damage, regardless of the age of hypertensive patients, regardless of the magnitude of the increase in blood pressure, and regardless of whether cardiovascular disease has developed.
Without the need for too many drugs, too many doses, and too complex treatment regimens, most patients with hypertension should target blood pressure below 130/80 mmHg, and if the patient can tolerate it, then blood pressure can be controlled to 120/70 mmHg, which may give the patient greater target organ protection [2].
Blood pressure targets in elderly patients
However, blood pressure targets need to be analyzed on a patient-by-patient basis, especially in the elderly population aged 60 years and older. In the past, it was thought that the blood pressure target for the elderly should be appropriately relaxed and controlled below 140 to 150/90mmHg, but the new research results have different hints.
Just last year, a STEP study in mainland China for patients with hypertension aged 60 to 80 years pointed out that comparing the conventional blood pressure target (systolic blood pressure less than 150 mmHg) and the stricter blood pressure target (systolic blood pressure less than 130 mmHg), after 3.34 years of median follow-up observation, it was found that a group of patients with lower blood pressure targets had a significantly lower risk of cardiovascular and cerebrovascular events, and that intensive blood pressure reduction did not increase the risk of serious adverse events and kidney damage compared with the two groups [3].
Therefore, the recommendation states that for elderly hypertensive patients aged 65 to 80 years, the blood pressure should first be reduced to less than 140 to 150/90 mmHg, and if the patient can tolerate it, it should be further reduced to less than 130/80 mmHg. However, if the patient is older, has poor physical condition, or has cognitive dysfunction, debilitation and other diseases, individual antihypertensive goals can be set according to the specific situation.
For patients over 80 years of age, antihypertensive therapy should start in small doses, gradually increasing the dose and type of the drug according to the patient's tolerance, and the adverse reactions and tolerability should be closely observed during treatment, and the intensity of treatment can be reduced if necessary.
The "Recommendations" also pointed out that while paying attention to blood pressure goals, it is also necessary to pay attention to the standardized measurement of blood pressure, even if blood pressure is measured in the hospital clinic, the environment is not quiet enough, and the patient does not have sufficient rest before measuring blood pressure, which will affect the accuracy of the measurement results. Therefore, home blood pressure monitoring and ambulatory blood pressure monitoring are recommended as important methods for assessing blood pressure.
Brother Jian said
There are many patients with hypertension in mainland China, but the blood pressure control rate is very low, and paying attention to active control of blood pressure can more effectively reduce target organ damage such as cardiovascular and cerebrovascular events.
Experts suggest that the blood pressure target for most patients with hypertension should be below 130/80mmHg, and if tolerated, it is better to reduce it to 120/70mmHg.
For elderly hypertensive patients over the age of 60, the primary blood pressure target is 140 to 150/90 mmHg or less, and if tolerated, it can be set to less than 130/80 mmHg.
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