Optimal blood pressure on antihypertensive medication.

The optimal blood pressure (BP) level for a patient on antihypertensive medication should maximize the patient's well-being and simultaneously lower the risk for pressure-related cardiovascular-renal complications. The clinical expression of pressure-related complications such as stroke, heart failure, renal insufficiency, peripheral arterial disease, and cognitive decline takes many years to decades to manifest. Accordingly, the attainment of the ultimate target BP is rarely necessary, or even desirable, over short time periods (eg, weeks) because the absolute clinical risk within these time periods is quite low. However, overmedication or aggressive BP lowering over the short term increases the likelihood of treatment-related side effects. Thus, attainment of goal BP should be accomplished gradually over many weeks to months in order to maximize BP lowering at a given dose of medication(s). Recent target BP goals promulgated by the Sixth Report from the Joint National Committee (JNC VI) are based on the premise that the intensity of treatment directly corresponds to the magnitude of pretreatment risk. Thus, hypertensive persons with diabetes, renal disease, or heart failure have goal BP levels lower than 130/85 mm Hg. All other hypertensive individuals should attain BP levels minimally to lower than 140/90 mm Hg. Finally, there is now appropriate recognition of the pivotal role of BP reduction in forestalling pressure-related cardiovascular complications, even among high-risk persons with diabetes mellitus and renal insufficiency.