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Current status of aggressive blood pressure control.

ABSTRACT: The concept of treatment of hypertension has gone through wide swings over the years. From ignoring blood pressure (BP) treatment initially, to aggressive BP control recently. As newer and more effective drugs were developed, it was possible to lower BP to very low levels. However, recent studies have shown that aggressive BP control might not be in the best interest of the patient. Low levels of diastolic BP (DBP) have been associated with increased cardiovascular events, a situation known as the J-curve effect. This has been seen mostly with low DBP, since the coronary arteries are perfused during the diastolic phase of the cardiac cycle. Due to an autoregulatory mechanism, the heart is protected against wide fluctuations of BP. However, the presence of coronary heart disease, hypertension, especially with left ventricular hypertrophy, shift the curve to higher BP levels and makes the heart more liable to DBP fluctuations. The J-Curve effect has been reported by most investigators, but not by others. Recently, a J-Curve effect has been observed with systolic BP (SBP), as well. In contrast to the heart, the brain is very infrequently subjected to J-curve effect, and in contrast to the heart, the brain's blood flow autoregulation depends mostly on the SBP. A Medline search of the English literature on this subject was conducted between 1992 and 2010 and 11 pertinent articles were selected. These articles with collateral literature will be discussed in this concise review.

SUBMITTER: Chrysant SG

PROVIDER: S-EPMC3077816 | biostudies-other | 2011 Mar

REPOSITORIES: biostudies-other

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Current status of aggressive blood pressure control.

Chrysant Steven G SG

World journal of cardiology 20110301 3

The concept of treatment of hypertension has gone through wide swings over the years. From ignoring blood pressure (BP) treatment initially, to aggressive BP control recently. As newer and more effective drugs were developed, it was possible to lower BP to very low levels. However, recent studies have shown that aggressive BP control might not be in the best interest of the patient. Low levels of diastolic BP (DBP) have been associated with increased cardiovascular events, a situation known as t ...[more]

PMID: 21499494

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Project description:BackgroundCognitive function is a concern among the elderly, which is related to the quality of life, life expectancy, and economic burdens. The relationship between blood pressure (BP) control status, visit-to-visit BP variability, and cognitive function remains controversial.MethodsWe aimed to explore the association between BP control status at baseline, visit-to-visit BP variability, and cognitive function. This study included 3,511 elderlies in the China Health and Retirement Longitudinal Study, covering four waves for 7-year follow-up (baseline 2011, 2013, 2015, and 2018). BP was measured in Wave 2011, 2013, and 2015. Cognitive function was measured by Mini-Mental State Exam in Wave 2018. Participants were divided into two groups: mid-old group for reflecting midlife BP and cognition (45-59 years at baseline but aged 60 or over in Wave 2018), and old-old group for reflecting late-life BP and cognition (aged 60 or over at baseline). We use univariate analysis and general linear model to analyze.ResultsLate-life BP showed stronger associations with cognitive function than midlife BP. As to late-life BP control status, controlled hypertension group get higher cognitive score than uncontrolled hypertension group in language (adjusted β = -0.34, 95%CI -0.68 to 0.00), and untreated hypertension group in orientation (adjusted β = -0.41, 95%CI -0.72 to -0.11), language (adjusted β = -0.35, 95%CI -0.67 to -0.04), and total (adjusted β = -0.99, 95%CI -1.85 to -0.12). Regarding visit-to-visit BP variability, midlife visit-to-visit systolic blood pressure (SBP) variability was associated with language (adjusted β = -3.70, 95% CI -5.83 to -1.57), while late-life visit-to-visit SBP variability was associated with orientation (adjusted β = -2.99, 95% CI -4.84 to -1.14), recall (adjusted β = -1.69, 95% CI -2.89 to -0.48), language (adjusted β = -2.26, 95% CI -4.13 to -0.38), and total (adjusted β = -9.50, 95% CI -14.71 to -4.28); Midlife diastolic blood pressure (DBP) variability and pulse pressure (PP) variability showed a significant relationship with language (adjusted β = 3.25, 95% CI -1.31 to -5.19) and calculation (adjusted β = -0.26, 95% CI -0.47 to -0.04), respectively. No significant correlation was found between midlife BP control status, late-life visit-to-visit DBP variability, late-life visit-to-visit PP variability, and cognitive score. There was no significant correlation between BP and memory.ConclusionsBP control status and visit-to-visit BP variability were significantly related to cognitive function among the Chinese elderly. Receiving effective late-life antihypertensive treatment and keeping SBP stable might contribute to prevent the development of cognitive impairment and dementia, especially for orientation and language function.

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Current status of aggressive blood pressure control.

Publications

Current status of aggressive blood pressure control.

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