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Facts and fallacies of blood pressure control in recent trials: implications in the management of patients with hypertension.

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TLDR
It is concluded that their complex design precludes a simple interpretation, that several important questions remain unanswered and that direct evidence – particularly in support of lowering systolic BP below 140 or 130 mmHg – is urgently needed.
Abstract
A large body of clinical trial data indicates that a given difference in blood pressure (BP), as measured in the clinic, results in a given difference in outcome. This correlation underpins current US and European guidelines for the management of hypertension. However, findings from recent comparative trials may appear inconsistent with a fixed relationship between BP lowering and outcome benefit, at least at all BP ranges, at all levels of total cardiovascular risk and with all drug combinations. We review the findings of six of these recent trials and conclude that their complex design precludes a simple interpretation, that several important questions remain unanswered and that direct evidence - particularly in support of lowering systolic BP below 140 or 130 mmHg - is urgently needed.

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Citations
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Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document.

TL;DR: The objective of this study was to establish a baseline for the design of a systematic literature review of this type of treatment for high blood pressure using a simple, straightforward, and scalable procedure.
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Factors Influencing the Decline in Stroke Mortality A Statement From the American Heart Association/American Stroke Association

TL;DR: There is strong evidence that the decline in stroke mortality can be attributed to a combination of interventions and programs based on scientific findings and implemented with the purpose of reducing stroke risks, the most likely being improved control of hypertension.
References
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Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.

TL;DR: Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.
Journal ArticleDOI

Effects of an angiotensin-converting -enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients

TL;DR: Ramipril significantly reduces the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have a low ejection fraction or heart failure.
Journal Article

Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38

M R Stearne, +262 more
- 12 Sep 1998 - 
TL;DR: Tight blood pressure control in patients with hypertension and type 2 diabetes achieves a clinically important reduction in the risk of deaths related to diabetes, complications related to Diabetes, progression of diabetic retinopathy, and deterioration in visual acuity.
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