Wie tief soll der Blutdruck sein? Zielwerte nach Alter und Vorgeschichte

The management of blood pressure (BP) in secondary prevention after acute myocardial infarction (AMI) remains a matter of debate. Since no dedicated trials have specifically addressed BP control in patients recovering from an acute coronary syndrome, there are no evidence-based, prospective data to define precise BP targets in this population. Moreover, major international guidelines devote surprisingly little attention to BP management in the post-AMI setting, despite its recognized importance in reducing recurrent cardiovascular events. On one hand, BP-lowering may improve cardiac function by reducing afterload and myocardial oxygen consumption and by facilitating favourable ventricular remodelling. On the other hand, the concept of a J-shaped association-whereby excessive lowering of diastolic blood pressure may paradoxically increase cardiovascular risk, particularly in the early post-AMI period-remains a matter of ongoing uncertainty. Despite decades of investigation, this issue has not been definitively resolved and continues to raise debate within both the scientific community and among clinicians. In this review, we examine the current evidence supporting BP control in the context of secondary prevention following AMI, with an updated focus on the ongoing debate surrounding the potential implications of the J-shaped phenomenon.

Recent clinical trials have raised important questions regarding optimal blood pressure (BP) targets in older adults with hypertension. In the 2019 Japanese Society of Hypertension guidelines, a systolic BP (SBP) target of <140 mmHg is recommended for individuals aged ≥75 years. However, subsequent randomized controlled trials (RCTs) have shown potential cardiovascular and mortality benefits associated with strict BP targets. We conducted an updated systematic review and meta-analysis to evaluate the efficacy and safety of intensive SBP control (<130 mmHg) compared with less intensive control (≥130 mmHg) in patients with hypertension aged ≥75 years. We searched MEDLINE, Cochrane Library, and Ichushi Web for publications up to May 30, 2024, supplemented by manual searches. Seven RCTs that met predefined eligibility criteria were included in the final meta-analysis. Among patients aged ≥75 years, intensive SBP lowering was associated with significantly reduced risks of composite cardiovascular events (risk ratio [RR]: 0.61, 95% confidence interval [CI]: 0.40-0.94, p = 0.03), all-cause mortality (RR: 0.72, 95% CI: 0.56-0.93, p = 0.01), and cardiovascular mortality (RR: 0.55, 95% CI: 0.35-0.88, p = 0.01), with no increase in serious adverse events (RR: 1.00, 95% CI: 0.93-1.08, p = 0.97). Stroke incidence did not differ significantly between groups. Similar results were observed when the analysis was expanded to include studies that enrolled participants aged ≥70 years. These find

<h4>Background and aims</h4>Blood pressure (BP) lowering reduces cardiovascular disease (CVD) risk; however, the benefits of treating patients with normal systolic BP but elevated diastolic BP remain uncertain.<h4>Methods</h4>Data from 51 randomized controlled trials were pooled to compare BP-lowering effects in participants with and without isolated diastolic hypertension (IDH), defined as systolic BP < 130 mmHg and diastolic BP ≥ 80 mmHg. Treatment effects were stratified across baseline diastolic BP categories (range < 60 to ≥90 mmHg) among individuals with baseline systolic BP < 130 mmHg. Fixed-effect one-stage individual participant data meta-analyses were used, and Cox proportional hazard models, stratified by trial, were applied to analyse the data.<h4>Results</h4>Among 358 325 participants, 15 845 (4.4%) had IDH. At a median follow-up of 4.2 years, a 5 mmHg reduction in systolic BP reduced the risk of major cardiovascular events similarly in individuals with IDH [hazard ratio 0.91; 95% confidence interval (CI) 0.82-1.01] and those without IDH (hazard ratio 0.90; 95% CI 0.89-0.92; P for interaction = 1.00). Analyses by baseline diastolic BP showed no evidence of heterogeneity in treatment effects among individuals with baseline systolic BP < 130 mmHg (P for interaction = .26). Relative treatment effects were not statistically different by CVD history, age, prior medication use, and BP measurement methods.<h4>Conclusions</h4>The study found no evidence to suggest that p

This article briefly reviews the latest hypertension guidelines and how they should be individualised in patients with heart failure (HF), including the two specific phenotypes: HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Key recent trials and guidelines show that HF medications remain beneficial and safe to use even in patients without overt hypertension, provided that they are tolerated. We also outline practical strategies for titration and selection of HF medications, most of which affect BP, in an outpatient setting. These strategies are applicable to both normotensive patients and those with pre-existing hypertension.

<h4>Background and aims</h4>A hypertensive response to exercise is independently associated with cardiovascular disease (CVD), but clinical interpretation may be confounded by aerobic capacity (fitness). The aim of this study was to determine the relationship between exercise blood pressure (BP) relative to fitness and CVD events.<h4>Methods</h4>Clinical exercise test records were analysed from 12 743 people (aged 53 ± 13 years, 60% male) who completed a standard exercise stress test (Bruce treadmill protocol, stages 1-4) at six Australian hospitals. Records were linked to administrative datasets (hospital and emergency admissions, death register) to define clinical characteristics and the primary outcome of fatal/non-fatal CVD events. Exercise systolic BP relative to fitness was calculated from the quotient of systolic BP and peak METs (SBP/METPeak). Competing risks regression was undertaken to compare events across quartiles, at the 90th percentile, and at various thresholds of SBP/METPeak.<h4>Results</h4>Over a median follow-up of 51 months (interquartile range: 32-75 months), 1349 events occurred. Exercise systolic BP without consideration of fitness was not associated with cardiovascular events (P > .05). In models adjusted for age, sex, and pre-exercise systolic BP, there was a stepwise increase in cardiovascular events across SBP/METPeak quartiles at stages 1-3 and peak (fourth quarter hazard ratios [HR]: stage 1 HR 2.54, 95% confidence interval [CI] 2.08-3.12; stage 2

The role of blood pressure variability (BPV) as an important marker of cardiovascular (CV) health, specifically its relationship with arterial stiffness and left ventricular remodeling in patients with hypertension, was investigated. This review aimed to elucidate the intricate relationship between BPV, arterial stiffness, and cardiac remodeling. BPV, as both a risk factor and a target of treatment, was also evaluated. The results point to the pivotal role of BPV in cardiovascular events, serving as an independent factor contributing to arterial stiffness and adverse left ventricular remodeling. The article concludes that BPV is a modifiable risk factor and that there is a need for an intervention in specific regions. BPV is a therapy target that is significant in the treatment of hypertension. The optimization of risk and prevention needs a multidisciplinary approach involving rehabilitation therapy, which will improve cardiovascular conditions and patient outcomes.