Intensive Blood Pressure Management

Intensive management targets a systolic blood pressure ≤120 mmHg and may be considered in high-risk patients who are ≥50 years old, have systolic blood pressure ≥130 mmHg and have any of the following:

• Clinical or subclinical cardiovascular disease
• Chronic kidney disease (nondiabetic nephropathy, proteinuria <1 g/d, eGFR 20-59 mL/min/1.73 m2)
• Framingham risk score ≥15%
• Age ≥75 years

This approach is based on The Systolic Blood Pressure Intervention Trial (SPRINT).

During SPRINT, patients treated intensively (<120 mmHg), instead of routinely (<140 mmHg), had a 25% lower relative risk of major cardiovascular events and death and a 27% lower relative risk of death from any cause.

Patients who may not be suitable for intensive management include those with:

• Secondary hypertension
• Diabetes
• Recent heart attack (within 3 months)
• History of stroke
• Heart failure (reduced left ventricular ejection fraction <35%)
• Kidney disease (eGFR <20)
• Standing SBP <110 mmHg following one minute of standing
• Frail or institutionalized elderly