{"id":30457,"date":"2026-06-05T04:45:00","date_gmt":"2026-06-04T20:45:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=30457"},"modified":"2026-06-05T05:42:22","modified_gmt":"2026-06-04T21:42:22","slug":"nejm%e4%b8%b4%e5%ba%8a%e5%86%b3%e7%ad%96%ef%bc%9a%e9%ab%98%e8%a1%80%e5%8e%8b%e7%ae%a1%e7%90%86%e7%9a%84%e8%a1%80%e5%8e%8b%e7%9b%ae%e6%a0%87%ef%bc%88%e7%ad%94%e6%a1%88%ef%bc%89","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=30457","title":{"rendered":"[NEJM\u4e34\u5e8a\u51b3\u7b56]\uff1a\u9ad8\u8840\u538b\u7ba1\u7406\u7684\u8840\u538b\u76ee\u6807\uff08\u7b54\u68481\uff09"},"content":{"rendered":"\n

CLINICAL DECISIONS<\/a><\/p>\n\n\n\n

Blood-Pressure Targets in Hypertension Management<\/h1>\n\n\n\n

Christos P. Kotanidis, Paul K. Whelton, Clinton B. Wright<\/h3>\n\n\n\n

N Engl J Med 2026;394:1026-1029<\/h3>\n\n\n\n

DOI: 10.1056\/NEJMclde2505268<\/h3>\n\n\n\n

CASE VIGNETTE<\/h2>\n\n\n\n

A Man with Hypertension<\/p>\n\n\n\n

Christos P. Kotanidis, M.D., D.Phil.<\/p>\n\n\n\n

A 75-year-old man comes to your primary care practice for a routine follow-up appointment. His medical history is notable for hypertension that is managed with ramipril and amlodipine. He is a retired architect who lives with his partner. In recent months, he has had increasing difficulty with activities of daily living, such as climbing stairs and walking long distances, primarily because of chronic joint pain, which has led him to reduce his activity levels. He does not smoke and drinks alcohol only socially. He is particularly conscious of his health and keeps a daily blood-pressure diary. In addition to the blood-pressure medications, he takes atorvastatin, at a dose 40 mg daily, and occasionally takes nonsteroidal antiinflammatory drugs to manage his chronic joint discomfort.<\/p>\n\n\n\n

On physical examination, his blood pressure is 138\/86 mm Hg, and his heart rate is 78 beats per minute. You notice a bruise on his left forearm and right lower leg. He mentions having had a couple of falls when getting out of bed in the morning, although this has occurred only twice in the past 6 months. Heart examination and lung auscultation are normal. You perform a lying\u2013standing blood-pressure measurement, which shows that the systolic blood pressure decreases by 11 mm Hg within 3 minutes after he stands from a supine position.<\/p>\n\n\n\n

Laboratory testing shows a total cholesterol level of 200 mg per deciliter (5.2 mmol per liter) and a high-density lipoprotein cholesterol level of 65 mg per deciliter (1.7 mmol per liter). Kidney-function and liver-function tests and a complete blood count are normal. According to his blood-pressure diary, his average systolic blood pressure is 136 mm Hg. You calculate, on the basis of the Framingham risk score, that his 10-year risk of cardiovascular disease is 17.6%.<\/p>\n\n\n\n

You must decide whether to intensify the antihypertensive therapy to target a systolic blood pressure of less than 120 mm Hg or to maintain the current therapy, with a systolic blood-pressure target of less than 140 mm Hg.<\/p>\n\n\n\n

TREATMENT OPTIONS<\/h2>\n\n\n\n

Which one of the following approaches would you recommend for this patient? Base your choice on the literature, your own experience, published guidelines, and other information.<\/p>\n\n\n\n

    \n
  1. Target a systolic blood pressure of less than 120 mm Hg.<\/li>\n\n\n\n
  2. Target a systolic blood pressure of less than 140 mm Hg.<\/li>\n<\/ol>\n\n\n\n

    To aid in your decision making, we asked two experts in the field to summarize the evidence in favor of approaches assigned by the editors. Given your knowledge of the issue and the points made by the experts, which approach would you choose?<\/p>\n\n\n\n

    OPTION 1<\/h3>\n\n\n\n

    Target a Systolic Blood Pressure of Less Than 120 mm Hg<\/p>\n\n\n\n

    Paul K. Whelton, M.B., M.D.<\/p>\n\n\n\n

    This patient is an older man who is at high risk for cardiovascular disease, with hypertension, hyperlipidemia, and chronic joint pain. Both his initial office and average home blood-pressure readings are high despite treatment with ramipril and amlodipine. I recommend attempting further reduction of his systolic blood pressure under careful supervision. This recommendation is based on a large body of observational and clinical trial evidence that shows that a lower average systolic blood pressure is likely to yield substantial benefits. Lifestyle counseling and better pain management, which would facilitate increased physical activity, are warranted. No single-pill combination of his current antihypertensive therapies is approved by the Food and Drug Administration (FDA). However, approximately 30 FDA-approved dual-therapy single-pill antihypertensive medications are available in the United States, most of which are relatively inexpensive generic combinations, along with 3 FDA-approved single-pill triple-therapy combinations. Initiation of a low-dose dual-therapy single-pill antihypertensive medication, followed by a triple-therapy combination if the hypertension is still uncontrolled, is likely to result in much better blood-pressure control and improved adherence.<\/p>\n\n\n\n

    A meta-analysis that pooled data from high-quality trials and compared outcomes in patients similar in age and cardiovascular disease risk to the patient in the vignette showed important benefits among those randomly assigned to systolic blood-pressure treatment targets of less than 130 mm Hg as compared with a higher systolic blood pressure and those assigned to a systolic blood pressure of less than 120 mm Hg as compared with less than 140 mm Hg.1<\/a><\/sup> For the latter comparison, the meta-analysis showed that the patients assigned to the lower systolic blood-pressure target had an 18% lower incidence of major cardiovascular disease events (stroke, coronary heart disease, heart failure, and death from cardiovascular causes) and 13% lower all-cause mortality during approximately 4 years of follow-up, as well as a significantly lower incidence of the individual components of the composite major cardiovascular disease end point. More intensive treatment has also resulted in better cognitive function2<\/a><\/sup> and a 15% lower risk of dementia.3<\/a><\/sup><\/p>\n\n\n\n

    This patient has possible postural hypotension, with a history of two early-morning falls during the preceding 6 months. Although this history underscores the need for careful implementation and close monitoring of the new antihypertensive regimen, it should not be an impediment to attempting blood-pressure reduction. Exacerbation of hypotension is possible but unlikely,1<\/a><\/sup> and in a meta-analysis, intensive antihypertensive therapy yielded almost identical cardiovascular disease reduction benefits in those with and those without hypotension at baseline.4<\/a><\/sup> Physical activity is important, not only for reduction in blood pressure and in the risk of cardiovascular disease, but also for personal well-being and quality of life. The patient\u2019s pain may be able to be managed without the need for nonsteroidal antiinflammatory drugs, but if they are needed, these drugs are likely to raise the systolic blood pressure by less than 5 mm Hg. If pain relief is inadequate to permit aerobic or dynamic resistance exercises, isometric resistance exercises that do not require joint movement, such as wall sits or yoga poses, could be used. Recent trials and large meta-analyses have shown large reductions in systolic blood pressure of more than 8 mm Hg with this type of physical activity.5<\/a><\/sup><\/p>\n\n\n\n

    With a combination of health promotion, patient-centered team-based care, a single-pill antihypertensive drug combination, and judicious monitoring, there is a high probability of substantial improvement in this patient\u2019s blood-pressure control and quality of life, reduction in cardiovascular disease complications and dementia, and improved longevity. As always, shared clinician\u2013patient decision making and careful clinical monitoring are essential.<\/p>\n","protected":false},"excerpt":{"rendered":"

    CLINICAL DECISIONS Blood-Pressure Targets in Hypertensi […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[13,18],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30457"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30457"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30457\/revisions"}],"predecessor-version":[{"id":30462,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30457\/revisions\/30462"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30457"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30457"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30457"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}