What evidence has been found to discourage aggressive reduction in BP in high risk groups?
Evidence to discourage aggressive reduction in BP in high risk groups comes from secondary analyses of outcomes associated with achieved BPs in the context of large RCTs. In a cohort of 4071 very elderly (Z80 years) ambulatory American veterans (hence 96.6% males) with hypertension on 1.7 1.2 (mean SD) antihypertensive medication classes, a J-shaped survival curve was noted when the relationship between both systolic and diastolic pressure and survival was examined. The optimum survival was associated with the ranges of diastolic BP between 70 79mm Hg and systolic BP between 130- In another smaller study (n 331) of mortality with 2 year follow-up in elderly hospitalized subjects 470 years with vascular disease or hypertension, the longest survival was observed when diastolic BP was in the range 71 80mm Hg, with a pronounced increase in risk with diastolic BP r60mmHg.410