The recommendation to further reduce blood pressure in patients with renal insufficiency or diabetes is not evidence-based: for renal insufficiency, there is no evidence of benefit for having target values <140/90 mm Hg (1); for diabetes mellitus, it can even be harmful (2). Lowering diastolic blood pressure <80–70 mm Hg for people over 65 is not only not evidence-based—this recommendation seems downright dangerous for older people. It remains completely incomprehensible why the recommendations of the German College of General Practitioners and Family Physicians’ (DEGAM) S3 Guideline on Cardiovascular Prevention of 2017 (3), which is valid in Germany, was not mentioned in the article (4). In the Guideline, an unanimous consensus was reached for the following recommendations (as well as for others):
The primary goal of antihypertensive treatment is to reduce the overall cardiovascular risk. In general, the target blood pressure should be =140 mm Hg systolic and =90 mm Hg diastolic.
For persons over 80, the decision to start or stop therapy should be made on a case-by-case basis.
The primary selection of antihypertensives should be based on efficacy, tolerability, comorbidities, and cost.
Footnotes
Conflict of interest statement
The author declares that no conflict of interest exists.
References
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