Editorials

Blood pressure targets in primary care

BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i813 (Published 25 February 2016) Cite this as: BMJ 2016;352:i813
  1. Christiane Muth, senior researcher in general practice1,
  2. Marjan van den Akker, epidemiologist and associate professor2 3,
  3. Paul P Glasziou, general practitioner and professor of evidence based medicine4
  1. 1Institute of General Practice, Johann Wolfgang Goethe University, D-60590 Frankfurt, Germany
  2. 2Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, Netherlands
  3. 3Academic Center for General Practice/Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
  4. 4Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, Robina, QLD 4226, Australia
  1. Correspondence to: C Muth muth{at}allgemeinmedizin.uni-frankfurt.de

A balancing act between the certainty of evidence and the messier reality of everyday practice

Management of high blood pressure is crucial, to forestall end organ damage, disability, and death and to reduce societal costs from cardiovascular disease. Good management is particularly important in general practice, where most patient care occurs.1 Recent clinical practice guidelines recommend treatment to systolic blood pressure (SBP) targets of <140 mm Hg,2 3 4 5 but for patients at high risk, such as those with previous stroke, many guidelines recommend lower targets.2 3 5

Is a lower SBP target feasible in general practice? The linked randomised controlled trial by Mant and colleagues (doi:10.1136/bmj.i708)6 investigated the effects of an SBP target of below 130 mm Hg or a reduction in SBP of at least 10 mm Hg to reduce the recurrence of cerebrovascular events among adults with a history of previous stroke or transient ischaemic attack.7 Control participants had an SBP target of below 140 mm Hg. Participants in both groups had their blood pressure checked quarterly by a practice nurse (or monthly if SBP was …

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