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Conservative versus aggressive blood pressure reduction: Do we have a winner?

      Arterial hypertension is an established cardiovascular risk factor [
      • Collaborators G.B.D.R.F
      Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.
      ], while antihypertensive therapy is associated with substantial cardiovascular benefits [
      • Lewington S.
      • Clarke R.
      • Qizilbash N.
      • Peto R.
      • Collins R.
      Prospective Studies C. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
      ]. Therefore, research in the field of hypertension has moved to more expanded boundaries, aiming to address whether aggressive blood pressure reduction is superior to the conservative one. Several randomized trials have been conducted in the past without definite conclusions (probably due to inadequate numbers of participants), while in the last decade three large studies (ACCORD, SPS3, and SPRINT) [

      The ACCORD Study Group.Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362:1575–1585.

      ,
      • Study Group S.P.S.
      Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial.
      ,
      The SPRINT Research Group
      A randomized trial of intensive versus standard blood-pressure control.
      ] yielded contradictory findings. Recently, the STEP study and the final analysis of the SPRINT study [
      The SPRINT Research Group
      Final report of a trial of intensive versus standard blood-pressure control.
      ,
      • Zhang W.
      • Zhang S.
      • Deng Y.
      • Wu S.
      • Ren J.
      • Sun G.
      • et al.
      Trial of intensive blood-pressure control in older patients with hypertension.
      ] showed significant cardiovascular benefits in their intensive arms, pointing towards aggressive antihypertensive therapy.
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