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Background Although numerous studies have demonstrated a strong association between blood pressure (BP) and hemorrhagic complications of antithrombotic therapy, there is still a paucity of information regarding the status of BP control in hypertensive patients on antithrombotic therapy. Methods This cross-sectional, retrospective study was conducted at an outpatient clinic to examine BP control and its associated factors in hypertensive patients receiving or not receiving antithrombotic therapy. Results Of 26,803 outpatients who had scheduled visits in 2018, 7,800 hypertensive patients met the inclusion criteria, of whom 1,727 cases were on oral antithrombotic drugs. Then, target BP values were defined according to the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2019. While BP values <140/90 mmHg were observed in 63.0% and 61.6% of patients with and without antithrombotic therapy, respectively, only 31.1% and 23.4% of them displayed BP values <130/80 mmHg. Multivariable logistic analysis indicated that comorbidity with obesity was a significant correlate of insufficient BP control (target BP <130/80 mmHg) in hypertensive patients, irrespective of antithrombotic therapy (patients with antithrombotic therapy, odds ratio (OR) = 1.690, 95% confidence interval (CI) = 1.351–2.113; patients without antithrombotic therapy, OR = 1.475, 95% CI = 1.290–1.687). Conclusion The majority of patients exhibited BP values <140/90 mmHg, whereas BP values <130/80 mmHg were achieved only in a small proportion of the patients. Furthermore, obesity appeared to be one of the factors contributing to insufficient BP control in a real-world setting. [ABSTRACT FROM AUTHOR]

Blood pressure (BP) control status was investigated using data of a health checkup held in a Japanese city. In fiscal year 2017, 54,287 persons (age, 40–74 years; males, 49%) underwent the checkup; 28,167 examinees had a systolic BP ≥140 mmHg, a diastolic BP ≥90 mmHg, or took antihypertensive agents. Of these subjects, 20,153 subjects took antihypertensive agents. A BP <140/90 was achieved in 66.6% (13,426) of the treated subjects; however, a BP <130/80 was achieved only in 30.7% (6,188). In conclusion, in 2017, although a relatively large proportion of treated subjects achieved a BP <140/90 mmHg with antihypertensive agents, only approximately half of these subjects reached a BP <130/80 mmHg, which is the latest treatment target for persons aged 75 years or less according to the Japanese hypertension guidelines 2019. [ABSTRACT FROM AUTHOR]

Intracranial hemorrhage and stroke are primary causes of maternal mortality in pregnancies affected by hypertensive disorders. As such antihypertensive therapy plays a crucial role in the management of severe hypertension. However, the target level to achieve the best outcome for both - mother and fetus - is still unclear. Moreover, given the lack of well-designed randomized controlled trials with standardized key outcomes, the current choice of antihypertensive medications depends rather on clinicians' preference. Furthermore, data on long-term outcomes of offspring is not available. Therefore, there is an urgent need for randomized trials comparing different anti-hypertensive options to address efficacy and safety questions. [ABSTRACT FROM AUTHOR]

Introduction: Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, and hypertension is its most prevalent modifiable risk factor. Patients with CAD and concomitant hypertension are a special population with distinct physiologic and structural alterations. Optimal blood pressure (BP) control in this population has been linked with reduction in adverse outcomes, however, excessive lowering of BP could jeopardize myocardial and cerebral perfusion. Areas covered: Authors highlight the prevalence of the CAD and hypertension dyad, as well as the implications of various structural and physiological changes in this population. Subsequently, available data on optimal BP targets in such patients, and lastly the J-curve phenomenon as well as antihypertensive agent use are discussed. Expert commentary: Current guideline recommendations are based on data from trials such as SPRINT and ACCORD which did not specifically focus on the CAD population. Based on data from observational studies and post hoc analyses, the best therapeutic systolic (SBP) and diastolic (DBP) targets may be ~ 130 mmHg and ~ 80 mmHg, respectively. Caution should be taken to not lower SBP below 120 mmHg and DBP below 60 mmHg. [ABSTRACT FROM AUTHOR]

Home blood pressure (HBP) measurement is useful for detecting morning hypertension, white coat as well as masked hypertension. However, target BP levels based on HBP remain unknown. The purpose of the present study was to evaluate the relationship between HBP measurement and office BP control status in hypertensive patients. Subjects were a total of 720 hypertensive outpatients (mean age: 64 ± 11 years; females: 57%). Two-time averaged office BP in 2005 were categorized as excellent (<130/85 mmHg), good (≥130/85 and <140/90 mmHg), or poor (>140/90 mmHg) control. In all patients, 37% were classified as excellent, 37% as good, and 26% as poor control. A total of 393 (55%) patients regularly measured HBP (HBP group). More women belonged to the HBP group (62 vs. 52%, p < 0.05). The HBP group also showed lower body mass index (23.8 ± 3.3 vs. 24.7 ± 3.4 kg/m2, p < 0.01), lower triglyceride (136 ± 78 vs. 158 ± 89 mg/dl, p < 0.01), and lower blood glucose (104 ± 20 vs. 118 ± 42 mg/dl, p < 0.01). HBP group showed a significantly higher prevalence of poor BP control (33 vs. 23%, p <0.01) and higher office SBP (134.5 ± 14.5 vs. 131.3 ± 11.7 mmHg, p < 0.01) than those who did not measure HBP (non-HBP). In a multivariate analysis for office SBP, age (partial r = 0.21, p < 0.05) and HBP measurement (partial r = 0.12, p < 0.05) were detected as significant independent variables. These results suggest that HBP measurement may lead to less strict office BP control unless the target HBP levels are clearly indicated. Until the recommendations or target HBP levels are available, we should make an effort to obtain goal office BP. [ABSTRACT FROM AUTHOR]

Pharmacological treatment of hypertension significantly reduces the incidence of cardiovascular diseases. Unfortunately, only a fraction of hypertensive patients benefit maximally from the protection afforded by the blood pressure lowering, mainly because the blood pressure control achieved during antihypertensive therapy remains often insufficient. One way to improve this situation is to individualize the treatment in determining for each patient the most simple drug regimen, which is at the same time efficacious and well tolerated. To this end, combining small doses of drugs acting by different mechanisms is often required. It is also essential that physicians develop skills to motivate their patients to comply lifelong with the treatment. [ABSTRACT FROM AUTHOR]