Are there new threshold and goals in the treatment of arterial hypertension?

About half of the global burden of cardiovascular disease has been attributed to high blood pressure (BP). Worldwide, 7·6 million premature deaths (about 13·5% of the global total), 54% of strokes, and 47% of cases of ischemic heart disease were caused by high BP in 2001. All guidelines agree that pharmacological treatment of patients with hypertension should be initiated as soon as BP rises >140/90 mmHg. Available data support the reduction of BP to values to <140/90 mmHg, but do not favor a reduction to <130/80 mmHg in patients with diabetes or a history of cardiovascular disease because of the absence of evidence obtained in prospective studies. This review updates the controversies and challenges involved in the treatment of patients with established arterial hypertension, such as the progression of high-normal BP to overt hypertension, the choice of appropriate threshold and goal BP levels, the adequate number of drugs to be used since the early stages of hypertension, and which type of combination therapy offers most advantages to the patient. © 2012 The Authors. European Journal of Clinical Investigation © 2012 Stichting European Society for Clinical Investigation Journal Foundation.