What evidence is there regarding the lowest blood pressure target for people with co-morbidities?
Most of the relevant evidence regarding the lowest blood pressure target for people with co-morbidities is observational, derived from retrospective analyses, and nearly all involves non-CKD populations. A cohort study of 860 US veterans showed greater mortality when systolic BP was o133 mm Hg or diastolic BP o65 mm Hg, although it appeared that the association might not be causal but instead related to atherosclerotic CVD as a co-morbidity. The available evidence is enough to support guideline statements advising caution in those with co-morbidity, however it is not robust enough to allow for a lower limit for either systolic BP or diastolic BP to be specified. The NIH funded SPRINT trial may clarify this issue in the future.