Episode 102: Blood pressure targets: Bullseye or Bulls–t

In episode 102, Mike and James, with laser precision, look at the evidence around blood pressure targets. We cover data in non-diabetics, diabetics, chronic kidney disease and the elderly. At the end they agree that the BP target we used 30 years ago (140/90) is still pretty good. To prove the point James gives Mike some sublingual nifedipine and Mike demonstrates the J-curve by falling on the floor and ‘pretending’ to be unable to get up (faker!).

Show notes
1) Systematic review of intensive BP treatment

Cochrane review CD004349

2) ACCORD blood pressure study
N Engl J Med 2010;362:1575-8

3) CARDIO-Sis
Lancet 2009;374:525–33

4) AASK – chronic kidney disease
N Engl J Med 2010;363:918-29

5) INVEST – retrospective data
JAMA 2010;304:61-68

6) BP guidelines
US
Curr Hypertens Rep 2010; 12:290–295
The Seventh Report of the Joint National Committee on: Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. August 2004
Canadian
2009 Canadian Hypertension Education Program Recommendations: The Scientific Summary
European
J Hypertension 2009, 27:2121–2158

7) BP in the elderly
N Engl J Med 2008;358:1887-98
Hypertens Res 2008;31:1595-601
Hypertension 2010;56:196-202