Which patients with BP <140/90 mm Hg should receive antihypertensive treatment?

Giuseppe Mancia, MD, is professor emeritus at the University Milano-Bicocca, Italy, where he served as Chairman of the Division and Department of Internal Medicine for 20 years. He currently chairs the Foundation of the European Society of Hypertension and the Hypertension Center, Policlinico di Monza.

Which patients with blood pressure (BP) <140/90 mm Hg should receive antihypertensive treatment?

Giuseppe Mancia, MD: There is a condition in which there is evidence that starting treatment when BP is >130 mm Hg systolic or 85 mm Hg diastolic leads to patient protection. These are patients with a history of cardiovascular events, that is, those with a very high risk.

A very nice meta-analysis of trials, in which a subgroup of patients was in this condition—that is, a history of a coronary event and high-normal BP—showed that a modest reduction in BP <130 mm Hg, a 7-mm Hg systolic BP reduction, was associated with reduction in stroke and stroke plus coronary artery disease. According to the European guidelines, this is definitely a condition in which the threshold for treatment should be <140/90 mm Hg.

These 2 conditions are associated with different risks of outcomes because hypertension emergencies have a higher risk of cardiovascular events in the future, whereas hypertension urgencies do not seem to be particularly dangerous from this point of view.