Hypertension (HTN) is a common risk factor for atherosclerosis in all vascular systems and has consequences on the heart, brain, kidney, and peripheral vessels. It is also well known that control of HTN makes a huge impact on prevention of vascular events which cause significant morbidity and mortality.

How to cite this article: Vidyasagar S. Target Blood Pressure in Clinical Settings. Hypertens 2020;6(4):2-3.

Received 21-12-2020;

Accepted 24-12-2020;

There are different clinical types of hypertensive disorders in pregnancy. The management mainly lies in the hands of an obstetrician; however, a physician's role is often sought specially in chronic hypertension and when blood pressure (BP) remains uncontrolled. There is no doubt that severe hypertension ≥160/110 mm Hg will be treated expeditiously to prevent complications. It is in less severe hypertension, where the questions arise - what should be the cutoff to treat with medications, and what must be the goal of control that has to be achieved? The dilemma is due to the observations of increased incidence of small for gestational age newborns among those treated for mild hypertension. Research in the recent past has shown that strict control reduces severe hypertension though there was no significant benefit in terms of reduction in pregnancy loss, high-level neonatal care, or overall maternal complications. There is no clear consensus between various guidelines on indication to initiate medication for the control of hypertension and the target BP to be achieved. Considering the recent developments in the field, it appears prudent to control even mild-to-moderate hypertension effectively. Regardless of the type of hypertensive disorder of pregnancy, persistent BP ≥140/90 mmHg in clinic (or ≥135/85 mmHg at home) should be treated, aiming for a target BP of 110-140/85 mmHg in the office to reduce the likelihood of developing severe maternal hypertension, and other complications. However, in gestational hypertension and preeclampsia, strict surveillance to identify worsening of the condition so as to take appropriate interventions

Key words: Blood pressure; hypertension, pregnancy-induced, preeclampsia, pregnancy outcome

How to cite this article: Guruvare S. Target Blood Pressure Goals for Treating Hypertension in Pregnancy. Hypertens 2020;6(4):4-7.

Received: 21-10-2020;

Accepted: 01-11-2020;

Guidelines for the management of hypertension have been constantly updated and with them targets for hypertension control have been evolving. There has been special concern for targets to achieve in hypertensive with coronary artery disease (CAD). Concern has been raised whether too low a value is harmful especially with concept of J curve being emphasized. This review attempts to analyze data for and against existence of a J curve and dissects various trials for and against this concept and attempts to come to a conclusion on ideal target for hypertension control in CAD patients. The data have been a little different in diabetics with CAD and trials in this field are also analyzed. Special concerns of tight hypertension control in the elderly are looked into. Mechanisms proposed for explaining J curve postulate are also discussed in the review. Approach of striking an ideal balance in therapy between good controls of systolic blood pressure with not so low diastolic blood pressure is proposed. Finally, an attempt has been made to zero in on ideal target blood pressure in various clinical spectra of vascular disease.

Key words: Coronary artery disease, hypertension, treatment targets

How to cite this article: Ramachandran P. How Tight Should Hypertension Control in CAD Be? - A Review. Hypertens 2020;6(4): 8-11.

Received: 21-10-2020;

Accepted: 01-11-2020;

Hypertension is a common disease in elderly people, and prevalence increases with age. It is associated with substantial morbidity and mortality. Newer, lowered definitions of hypertension further increase prevalence. There is no consensus between the hypertension guidelines on the precise definition of the elderly and the target blood pressure (BP) for the elderly. Due to the heterogeneity of this population, the goal of optimum BP regulation is also controversial. In this article, we review current data on hypertensive treatment guidelines, try to define the target BP, optimize treatment strategies in the elderly and summarize the challenges health provider face when dealing with this population.

Key words: Blood pressure, Cardiovascular, Elderly, Geriatrics, Hypertension

How to cite this article: Shivashankara KN, Hande MH. Target Blood Pressure Goals for Treating Hypertension in the Elderly: A Review. Hypertens 2020;6(4):12-18.

Received: 23-10-2020;

Accepted: 02-11-2020;

Stroke continues to be a globally leading cause of morbidity and mortality in today's scenario despite increasing awareness and newer interventions. Modifiable risk factors such as hypertension provide opportunities for early identification and optimal treatment to prevent stroke and improve outcomes if stroke occurs. The management of hypertension in stroke is multifaceted and requires proper identification and accurate definition of therapeutic goals. The goal of optimal blood pressure management in stroke has to balance target BP goals, cerebral perfusion and autoregulation to prevent worsening of tissue perfusion by aggressive BP lowering. The advent of intravenous and intra-arterial thrombolysis also requires emphasis on emergent management of accelerated hypertension to facilitate thrombolysis and post-thrombolysis care. This review aims at looking in depth at the traditional and newer clinical practices and evidence-based data on targets and methods of blood pressure control in cerebrovascular disease.

Key words: Cerebrovascular disease, target BP goals, thrombolysis

How to cite this article: Pai AR, Shetty N. Target Blood Pressure Goals in Cerebrovascular Disease. Hypertens 2020;6(4): 19-23.

Received: 28-10-2020;

Accepted: 07-11-2020;

Ever increasing pandemic of obesity, hypertension (HTN), and other factors that may contribute significantly to the cardiovascular morbidity and mortality in adulthood has shifted the focus from management of HTN to its prevention. Tracking of adult HTN from childhood HTN, increasing recognition of reversible childhood markers of target organ damage and effective interventions, both pharmacological and non-pharmacological, have made it mandatory for the clinicians to control childhood HTN more aggressively although deleterious effects of HTN may not be as commonly seen as in adults. A thorough literature search was conducted to formulate the target blood pressure (BP) goals in children/adolescents, mainly based on the European and American guidelines. Reduction in systolic and diastolic BP to <90^th percentile in children and <130/80 mm mercury in adolescents more than or equal to 13 years old is a consensus target BP goals in children. Reduction in BP levels <90th percentile in children and <130/80 in adolescents is a good control to prevent further progression. Prevention of early determinants of HTN, factors that determine BP tracking in childhood to adulthood and of end organ damage shall be the field of further research in this arena.

Key words: Childhood hypertension, goals, targets, treatment

How to cite this article: Mundkur SC. Target BP Goals in Children/Adolescents. Hypertens 2020;6(4):24-29.

Received: 25-10-2020;

Accepted: 04-11-2020;

Background: Hypertension is the leading cause of heart failure worldwide leading to adverse cardiovascular outcomes. However, little is known about the target blood pressure goals in patients with heart failure.

Body: Chronic hypertension leads to the left ventricular hypertrophy and further remodeling may cause heart failure with preserved ejection fraction and eventually heart failure with reduced ejection fraction. Various societal guidelines have come forward to decide on target blood pressure goals in specific high-risk populations. However, only some evidence is available on target blood pressure goals in heart failure patients and most of these data have been extrapolated from other studies. With the data currently available, treating hypertension at a level of 140/90 mmHg and titrating to 130/80 mmHg in patients with heart failure looks well justified. However, targeting blood pressure below 120/70 mmHg remains a gray zone and should ideally be avoided.

Conclusion: Further prospective studies are needed to define target blood pressure goals in patients with heart failure.

Key words: Heart failure, Hypertension, J Curve

How to cite this article: Rao MS, Dhanse S. Hypertension and Heart Failure. Hypertens 2020;6(4): 30-35.

Received: 25-10-2020;

Accepted: 03-11-2020;

Hypertension and diabetes mellitus (DM) are major risk factors for atherosclerotic cardiovascular diseases (ASCVD). The prevalence of hypertension is more in people with DM compared to general population augmenting the risk of ASCVD. A systolic blood pressure (SBP) reduction below 140 mmHg in diabetes subjects is known to reduce cardiovascular events and mortality beyond doubt in several trials. A SBP ≤130 mmHg should be targeted in individuals with high ASCVD risk scoring with careful monitoring for electrolyte imbalances and renal function. A target SBP of 130-139 should be targeted in elderly diabetes individuals with less strict control in patients with autonomic neuropathy and low diastolic BP (DBP). A DBP target of ≤80 mmHg should be attained in diabetes subjects with hypertension.

Key words: Diabetes mellitus, Hypertension, Artherosclerotic cardiovascular diseases

How to cite this article: Acharya V, Nandakrishna B. Target Blood Pressure in Diabetes Mellitus: A Review. Hypertens 2020;6(4):36-40.

Received: 28-10-2020;

Accepted: 05-11-2020;