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Treatment Objectives: How Much Acceptable?

Year 2017, Volume: 5 Issue: 5, 15 - 17, 04.05.2017

Abstract

Abstract

Blood pressure goals in hypertension treatment alter frequently. It is not certain tostart anti-hypertensive treatment in patients with lower BP levels and co-morbidities. ESCand ACC/AHA hypertension guidelines recommended <140/90 mmHg BP levels in mosthypertensive patients and < 150/90 mmHg levels in older patients as BP target levels.However, novel randomized trials and some meta-analysis revealed some supporting dataof lower BP levels in high risk and older patients.

References

  • Kaynaklar 1-Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, BirkenhägerWH, et al. Randomised double-blind comparison of placebo and ac-tive treatment for older patients with isolated systolic hypertension.The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators.Lancet. 1997 Sep 13;350(9080):757-64. 2-Prevention of stroke by antihypertensive drug treatment in older per-sons with isolated systolic hypertension. Final results of the Systo-lic Hypertension in the Elderly Program (SHEP). SHEP Coopera-tive Research Group.[No authors listed] JAMA. 1991 Jun26;265(24):3255-64. 3-Boutitie F, Gueyffier F, Pocock S, Fagard R, Boissel JP, INDANAProject Steering Committee. INdividual Data ANalysis of Antihyper-tensive intervention J-shaped relationship between blood pressureand mortality in hypertensive patients: new insights from a meta-analy-sis of individual-patient data. Ann Intern Med. 2002;136(6):438. 4-Staessen J, Bulpitt C, Clement D, De Leeuw P, Fagard R, FletcherA, et al. Relation between mortality and treated blood pressure inelderly patients with hypertension: report of the European WorkingParty on High Blood Pressure in the Elderly. BMJ.1989;298(6687):1552. 5-Arguedas JA, Perez MI, Wright JM. Treatment blood pressure tar-gets for hypertension. Cochrane Database Syst Rev. 2009 Jul 8;(3) 6-Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr,Cutler JA, et al. ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 Apr29;362(17):1575-85 7-Sundström J, Arima H, Woodward M, Jackson R, Karmali K, Lloyd-Jones D, et al. Blood Pressure Lowering Treatment Trialists' Col-laboration. Blood pressure-lowering treatment based on cardiovas-cular risk: a meta-analysis of individual patient data. Lancet. 2014Aug 16;384(9943):591-8. 8-Ogihara T, Saruta T, Rakugi H, Matsuoka H, Shimamoto K, Shima-da K, et al. Valsartan in Elderly Isolated Systolic Hypertension StudyGroup.. Hypertension. 2010 Aug;56(2):196-202. 9-Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Roc-co MV, et al. A Randomized Trial of Intensive versus Standard Blo-od-Pressure Control. SPRINT Research Group. N Engl J Med.2015;373(22):2103. 10-SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK,Snyder JK, Sink KM, Rocco MV et al. A Randomized Trial of Inten-sive versus Standard Blood-Pressure Control N Engl J Med 2015;373:2103-2116 10, 26, 2015 11-Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T et al. Effectsof intensive blood pressure lowering on cardiovascular and renal out-comes: updated systematic review and meta-analysis. Lancet.2016;387:435–443 12-Blood Pressure Targets in Subjects With Type 2 Diabetes Mellitus/Im-paired Fasting Glucose Observations From Traditional and Baye-sian Random-Effects Meta-Analyses of Randomized Trials Sripal Ban-galore, MD, MHA; Sunil Kumar, MD; Iryna Lobach, PhD; FranzH. Messerli, MD. 13-Jones DW. What should be the target blood pressure for CKD withovert proteinuria? J Hypertens. 2016 Sep;34 14-Franklin SS, Gokhale SS, Chow VH , Larson MG, Levy D, Vasan RSet al. Does low diastolic blood pressure contribute to the risk of re-current hypertensive cardiovascular disease events? The Framing-ham Heart Study. Hypertension, 2015 feb:65(2);299-305 15-Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm Met al; Task Force Members. 2013 ESH/ESC Guidelines for the ma-nagement of arterial hypertension: the Task Force for the manage-ment of arterial hypertension of the European Society of Hyperten-sion (ESH) and of the European Society of Cardiology (ESC).J Hyper-tens. 2013;31:1281–1357. 16-James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmel-farb C, Handler J et al. 2014 evidence-based guideline for the ma-nagement of high blood pressure in adults: report from the panel mem-bers appointed to the Eighth Joint National Committee (JNC 8). JAMA.2014;311:507–520

Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?

Year 2017, Volume: 5 Issue: 5, 15 - 17, 04.05.2017

Abstract

Öz

Hipertansiyon tedavisinde kan basıncı (KB) hedefleri devamlı değişmektedir. Ko-morbiditesi olan ve daha düşük KB değerleri olan hastalarda tedavi başlanmasının faydaları net değildir. ESC ve ACC/AHA hipertansiyon rehberleri çoğu hipertansif hastada <140/90mmHg, yaşlılarda ise <150/90 mmHg değerleri hedef KB değerleri olarak önermekte-dir. Fakat, yeni randomize çalışmalar ve bazı meta-analizler yüksek riskli ve yaşlı kişilerde daha düşük KB değerlerini destekleyen bazı veriler ortaya koymuştur.

References

  • Kaynaklar 1-Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, BirkenhägerWH, et al. Randomised double-blind comparison of placebo and ac-tive treatment for older patients with isolated systolic hypertension.The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators.Lancet. 1997 Sep 13;350(9080):757-64. 2-Prevention of stroke by antihypertensive drug treatment in older per-sons with isolated systolic hypertension. Final results of the Systo-lic Hypertension in the Elderly Program (SHEP). SHEP Coopera-tive Research Group.[No authors listed] JAMA. 1991 Jun26;265(24):3255-64. 3-Boutitie F, Gueyffier F, Pocock S, Fagard R, Boissel JP, INDANAProject Steering Committee. INdividual Data ANalysis of Antihyper-tensive intervention J-shaped relationship between blood pressureand mortality in hypertensive patients: new insights from a meta-analy-sis of individual-patient data. Ann Intern Med. 2002;136(6):438. 4-Staessen J, Bulpitt C, Clement D, De Leeuw P, Fagard R, FletcherA, et al. Relation between mortality and treated blood pressure inelderly patients with hypertension: report of the European WorkingParty on High Blood Pressure in the Elderly. BMJ.1989;298(6687):1552. 5-Arguedas JA, Perez MI, Wright JM. Treatment blood pressure tar-gets for hypertension. Cochrane Database Syst Rev. 2009 Jul 8;(3) 6-Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr,Cutler JA, et al. ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 Apr29;362(17):1575-85 7-Sundström J, Arima H, Woodward M, Jackson R, Karmali K, Lloyd-Jones D, et al. Blood Pressure Lowering Treatment Trialists' Col-laboration. Blood pressure-lowering treatment based on cardiovas-cular risk: a meta-analysis of individual patient data. Lancet. 2014Aug 16;384(9943):591-8. 8-Ogihara T, Saruta T, Rakugi H, Matsuoka H, Shimamoto K, Shima-da K, et al. Valsartan in Elderly Isolated Systolic Hypertension StudyGroup.. Hypertension. 2010 Aug;56(2):196-202. 9-Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Roc-co MV, et al. A Randomized Trial of Intensive versus Standard Blo-od-Pressure Control. SPRINT Research Group. N Engl J Med.2015;373(22):2103. 10-SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK,Snyder JK, Sink KM, Rocco MV et al. A Randomized Trial of Inten-sive versus Standard Blood-Pressure Control N Engl J Med 2015;373:2103-2116 10, 26, 2015 11-Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T et al. Effectsof intensive blood pressure lowering on cardiovascular and renal out-comes: updated systematic review and meta-analysis. Lancet.2016;387:435–443 12-Blood Pressure Targets in Subjects With Type 2 Diabetes Mellitus/Im-paired Fasting Glucose Observations From Traditional and Baye-sian Random-Effects Meta-Analyses of Randomized Trials Sripal Ban-galore, MD, MHA; Sunil Kumar, MD; Iryna Lobach, PhD; FranzH. Messerli, MD. 13-Jones DW. What should be the target blood pressure for CKD withovert proteinuria? J Hypertens. 2016 Sep;34 14-Franklin SS, Gokhale SS, Chow VH , Larson MG, Levy D, Vasan RSet al. Does low diastolic blood pressure contribute to the risk of re-current hypertensive cardiovascular disease events? The Framing-ham Heart Study. Hypertension, 2015 feb:65(2);299-305 15-Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm Met al; Task Force Members. 2013 ESH/ESC Guidelines for the ma-nagement of arterial hypertension: the Task Force for the manage-ment of arterial hypertension of the European Society of Hyperten-sion (ESH) and of the European Society of Cardiology (ESC).J Hyper-tens. 2013;31:1281–1357. 16-James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmel-farb C, Handler J et al. 2014 evidence-based guideline for the ma-nagement of high blood pressure in adults: report from the panel mem-bers appointed to the Eighth Joint National Committee (JNC 8). JAMA.2014;311:507–520
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Details

Primary Language Turkish
Journal Section Makaleler 1
Authors

Dr. Öner Özdoğan

Publication Date May 4, 2017
Published in Issue Year 2017 Volume: 5 Issue: 5

Cite

APA Özdoğan, D. Ö. (2017). Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?. Klinik Tıp Bilimleri, 5(5), 15-17.
AMA Özdoğan DÖ. Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?. Klinik Tıp Bilimleri. May 2017;5(5):15-17.
Chicago Özdoğan, Dr. Öner. “Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?”. Klinik Tıp Bilimleri 5, no. 5 (May 2017): 15-17.
EndNote Özdoğan DÖ (May 1, 2017) Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?. Klinik Tıp Bilimleri 5 5 15–17.
IEEE D. Ö. Özdoğan, “Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?”, Klinik Tıp Bilimleri, vol. 5, no. 5, pp. 15–17, 2017.
ISNAD Özdoğan, Dr. Öner. “Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?”. Klinik Tıp Bilimleri 5/5 (May 2017), 15-17.
JAMA Özdoğan DÖ. Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?. Klinik Tıp Bilimleri. 2017;5:15–17.
MLA Özdoğan, Dr. Öner. “Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?”. Klinik Tıp Bilimleri, vol. 5, no. 5, 2017, pp. 15-17.
Vancouver Özdoğan DÖ. Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?. Klinik Tıp Bilimleri. 2017;5(5):15-7.