7 mmHg at follow-up) compared with those given placebo (mean 140.3 mmHg), with an associated antiproteinuric learn more effect and a reduction in the incidence of new-onset micro- or macro-albuminuria [31]. Patients with diabetes frequently have a number of co-morbidities, meaning that an individualized approach to treatment may be warranted. Hypertensive patients who have experienced previous CV events have also demonstrated inconsistent outcomes following intensive Epigenetics inhibitor antihypertensive

treatment (to SBP <130 mmHg), depending upon the agent used [32–36]. Furthermore, the optimal BP target for protective effects on the kidney, brain, and heart may be divergent [30]. These data support a ‘common sense’ approach in high-risk individuals, individually

tailoring antihypertensive treatment and favoring those agents with proven CV benefits; however, in clinical practice, the most suitable drug combinations for any given patient are frequently MEK162 concentration not being prescribed. A number of RCTs involving elderly patients have shown a reduction in CV events through BP lowering, but the mean SBP achieved has not reached <140 mmHg [12]. Two recent trials of intensive vs. less intensive treatment failed to show a benefit of SBP reduction below 140 mmHg [37, 38], while the Felodipine EVEnt Reduction (FEVER) study sub-analysis

showed a reduction in stroke in 3,179 elderly patients by lowering SBP to just below 140 mmHg (vs. 145 mmHg) [39]. The Cardio-Sis trial involving 1,111 elderly patients (mean age: 67 years) selleck demonstrated that tight BP control (to a mean BP of 132.0/77.3 mmHg at 2 years) significantly reduced the incidence of left ventricular hypertrophy and a composite of fatal and non-fatal CV outcomes compared with usual care (which reduced mean BP to 135.6/78.9 mmHg at 2 years) [40]. This benefit of intensive treatment was not associated with an increase in AEs in these patients [40]. Therefore, despite a lack of RCT evidence for aggressive BP targets in high-risk hypertensive patients, which has driven the relaxed BP targets in the 2013 ESH/ESC guidelines, a number of studies have shown the benefits of more intensive BP lowering on various CV outcomes across patient groups. A ‘ceiling effect’ for treatment benefits has been described for high-risk patients, suggesting that early therapy to address CV risk before it reaches a high level may increase the benefit of intervention [41].