Evidence based medicine: the case of blood pressure targets
DOI:
https://doi.org/10.51481/amc.v59i3.966Keywords:
evidence based medicine, blood pressure targets, arterial hypertensionAbstract
The concept of ""Evidence Based Medicine"", which has achieved greater importance during the last years, is based on the idea that teaching and practicing clinical medicine, as well as the definition of health policies at the population level, should be supported by solid scientific evidences showing that there is an adequate relationship between the benefits and potential risks associated with the practical implementation of any preventive, diagnostic, or therapeutic intervention. Unfortunately, many of the usual actions in medical practice do not fulfill those conditions, which may result in inappropriate use of available resources and exposure of patients to unnecessary risks. ""Evidence Based Medicine"" starts from an exhaustive critical inquiry of the clinical studies that have evaluated a specific issue, in order to identify the available evidence with higher quality and scientific support, and from there to perform a quantitative analysis that allows determining if the benefits/risks balance justifies its clinical application. In addition, it is a dynamic process, whose results can be gradually modified as new quality evidence emerges, with the final objective of improving medical care. The case of blood pressure targets used in the treatment of arterial hypertension is a topic that has been subjected in recent years to the process of analysis of the evidence. As a result, changes and implications have occurred both at clinical and academic levels, and it serves as an example to illustrate the process described above.
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References
Evidence Based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA 1992;268: 2420-2425.
Laurent S. Guidelines from the British Hypertension Society. The lower the pressure the better. BMJ 2004;328:593-594
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560-2572.
World Health Organization, International Society of Hypertension Writing
Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003;21:1983-1992.
Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004;43 (5 Suppl 1):S1-290.
Williams B, Poulter NR, Brown MJ, et al. British Hypertension Society Guidelines for hypertension management 2004 (BHS-IV): summary. BMJ 2004;328:634-640.
Mancia G, De Backer G, Domiiczak A, et al. 2007 Guidelines for the management of arterial hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertension 2007;25:11051187.
Rosendorff C, Black HR, Cannon CP, et al. Treatment of hypertension in the prevention and management of ischemic heart disease. A scientific statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention. Circulation 2007;115:2761-2788.
Lewington S, Clarke R, Qizilbash N, et al; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a metaanalysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-1913.
Gueyffier F. Observational epidemiological studies: values and limitations. J Hypertens 2001;21:673-675.
MacMahon S, Collins R. Reliable assessment of the effects of treatment on mortality and major morbidity, II: observational studies. Lancet 2001;357:455462.
Hansson L, Zanchetti A, Carruthers SG, et al, for the HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998;351:1755-1762.
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998;317:703-713.
Arguedas JA, Perez MI, Wright JM. Treatment blood pressure targets for hypertension. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD004349. DOI: 10.1002/14651858.CD004349.
Arguedas JA. Blood pressure targets: are clinical guidelines wrong? Curr Op Cardiol 2010;25:350-354.
Filippone EJ, Foy A, Newman E. Goal directed antihypertensive therapy: lower may not always be better. Clev Clin J Med 2011;78:123-133.
Grossman E. Blood pressure: the lower, the better. The con side. Diabetes Care 2011;34 (suppl 2):308-312.
Arguedas JA, Leiva V, Wright JM. Blood pressure targets for hypertension in people with diabetes mellitus. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. 10: CD 008277.
Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension; the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281-1357.
James PA, Oparil S, Carter BL, et al. Evidence based guideline for the management of high blood pressure in adults. Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507-520.
Weber MA, Schiffrin EL, White B, et al. Clinical practice guideline for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens 2014;32:3-15.
American Diabetes Association. Cardiovascular disease and risk management. Diabetes Care 2016;39(Suppl1):S60-71.
JATOS Study Group. Principal results of the Japanese Trial to Assess Optimal Systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res 2008;31:2115-2127.
Ogihara T, Saruta T, Rakugi H, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study. Hypertension 2010;56:196-202.
The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Eng J Med 2000;342:145-153.
The European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized, double-blind, placebo-controlled, multicenter trial (the EUROPA Study). Lancet 2003;362:782-788.
Arguedas JA. Does our understanding of blood pressure targets in diabetes need rethinking? Diabetes Management 2014;4:215-218.
The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Eng J Med 2015;373:2103-2116.
Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and metaanalysis. Lancet 2016;387:435-443.
Laurent S, Boutouyrie P. Blood pressure lowering trials: wrapping up the topic? Lancet 2016;387:923-924.
The ACCORD Study Group. Effects of intensive blood-pressure control in type2 diabetes mellitus. N Eng J Med 2010;362:1575-1585.
The SPS3 Study Group. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet 2013;382:507-15.
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