News - Hypertension Week of June 8, 2003/ Vol. 2 No. 23

Study: Intensive Lowering of Diastolic Pressure May Not Benefit All With Hypertension

Reducing diastolic blood pressure to below 90 mmHg in patients with hypertension but without diabetes may not provide any benefits, according to an analysis of various studies reported in the Australian Prescriber.

Suzanne Hill, of the University of Newcastle in Australia, analyzed several hypertension studies. She found that only one -- the Hypertension Optimal Treatment (HOT) study -- examined the effect of lowering blood pressure to different targets in patients with or without diabetes.

According to Hill, the HOT study showed the benefits of lowering diastolic blood pressure to 82.6 mmHg and implied that the targets for the treatment of hypertension should be lower than the previously accepted mark of 90 mmHg.

But Hill said the HOT study does not provide sufficient evidence of the benefits of intensive treatment of blood pressure to reduce diastolic pressure below 90 mmHg in patients with hypertension, but without diabetes.

Hill added that the study did find that patients with diabetes in the lowest target blood pressure group had significantly lower rates of cardiovascular events and decreased mortality.

"This…highlights the need to consider hypertension in the context of the other risk factors that an individual patients possesses," said Hill. "Just lowering blood pressure to an arbitrary target, particularly in a low-risk patient, may not provide benefits and may cause harm."

Hill said one size rarely fits all for hypertensive patients without multiple risk factors for cardiovascular disease. "And a single target blood pressure for the treatment of hypertension across all patients groups is clearly not justified," she observed.

Other sources: Australian Prescriber (2003:26:53-5)