Hypertension blood pressure targets

Drug selection for the management of patients with hypertension should be considered as adjunctive to nonpharmacologic approaches for blood pressure lowering, and ultimately the attainment of target blood pressure in many cases maybe more important than the antihypertensive agent used. 

There is a strong consensus among national and international renal, hypertension and diabetes organisations to recommend a target blood pressure of <130/80mmHg for all patients with CKD. Whereas there is some evidence to support a lower target of <125/75mmHg in patients with >lg/day of proteinuria there is concern that lower blood pressures may be associated with adverse outcomes in some patients. 

Most patients with hypertension and CKD require drug regimens that include three or more antihypertensive agents to achieve target blood pressure. Blood pressure reductions can be achieved with agents in all antihypertensive classes, and choice should be guided by the individual patient s concomitant disease states. 

If the patient is hypertensive, ACEIs or ARBs should be used to control the blood pressure as well as the proteinuria. The target blood pressure should be <125/75 mm Hg. Some clinicians recommend using ACEIs or ARBs for all patients with >1 g/day proteinuria. In patients with recurrent macroscopic hematuria in conjunction with tonsillitis, tonsillectomy should be considered. In all of the patients. 

Finally, drug treatment in the elderly is of great importance and warrants special attention with regard to safety and tolerability, since systolic blood pressure is recognized as an important target for treatment, particularly in older persons. The benefits of antihypertensive treatment in the elderly and in patients with isolated systolic hypertension are greater than in younger persons. 

The direct target for Rho. The enzyme is inhibited by Y-27632, a compound that lowers elevated blood pressure in animal models of hypertension. 

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