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Intensive Blood Pressure Management

April 8, 2017

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

 

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  1. Hypertension | Dr. John's Blog

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