Benefits And Risks Of Antihypertensive Treatment How Far Can Diastolic Blood Pressure Be Lowered?

Article, see p 134 Through the years, management of hypertension has seen clinical interest moving from systolic (SBP) to diastolic (DBP) blood pressure (BP) and then back to SBP, but an interesting article published in the current issue of Circulation 1 reminds us that attention should be given to DBP also. As summarized in a previous review,2 when BP first became measurable at bedside thanks to the sphygmomanometer developed by Riva Rocci, hypertension could be defined only by SBP, but even after the introduction of the auscultatory method by Korotkoff in 1905 made DBP measurable, for many years, clinical studies on hypertensive cohorts, starting with the seminal article by Janeway3 in 1913, defined hypertensionalmost exclusively on the basis of SBP. However, when the first effective BP-lowering drugs were developed and randomized controlled trials of antihypertensive treatment were initiated, all interest was concentrated on DBP only, and until the 1990s, guidelines provided recommendations based only on DBP management. With the publication between 1991 and 1998 of the landmark trials showing the benefits of SBP lowering in isolated systolic hypertensionin the elderly,4–6 SBP was back as the almost exclusive target of hypertensionmanagement, the last remarkable example being the recent SPRINT trial (Systolic HypertensionBlood Pressure Intervention Trial),7 which was successfully designed to provide evidence of morbidity and mortality reduction by more versus less intense lowering of SBP. It appears meritorious, therefore, that the SPRINT authors now make a clever attempt to provide some relevant information relating DBP values to the benefits and risks of antihypertensive treatment.1The SPRINT results must be seen in the context of 2 major problems debated in recent studies and guidelines on hypertensionmanagement: …