Should Patients with Hypertension Be Treated Based on Blood Pressure or Overall Cardiovascular Risk?

Recent guidelines for lipid management have urged that patients be treated based on overall cardiovascular (CV) risk rather than on lipid concentrations (NEJM JW Gen Med Nov 12 2013), largely because a 2012 meta-analysis of lipid trials showed that baseline CV risk was the major determinant of the absolute benefit of statin therapy (NEJM JW Gen Med Jun 12 2012). However, guidelines for managing hypertension continue to focus largely on achieving target blood pressures.

Researchers applied the methods of the 2012 meta-analysis to >50,000 patients in 11 hypertension trials in which major adverse CV events were reported; trials were either placebo controlled or comparisons between intensive and less-intensive regimens. Based on known risk facto…