Treatment to lower high systolic blood pressure in nondiabetic patients is associated with a reduction in left ventricular hypertrophy (LVH), a thickening of the heart muscle that can lead to heart failure and rhythm problems. Thus, a lowering of systolic blood pressure targets from the currently recommended 140 mm/Hg or less to below 130 mm Hg should be the treatment goal in lowrisk patients with high blood pressure, concludes an Article published in this weeks edition of The Lancet.

Despite a lack of evidence, hypertension guidelines recommend that blood pressure be lowered to less than 140/90 mm Hg. Evidence from previous trials does lend support to a blood pressure target of below 130/80mm Hg in highrisk patients with cardiovascular disease or diabetes. However, the level to which systolic blood pressure should be lowered in patients without high cardiovascular risk has not been evaluated in clinical trials. Indeed, there is currently no evidence to support a lower treatment target in patients with high blood pressure without diabetes.

For the first time, Paolo Verdecchia from the Hospital S. Maria della Misericordia and ANMO Research Centre in Italy and colleagues conducted a randomised trial to examine the cardiovascular effects of a systolic blood pressure target below 130 mm Hg (tight control) compared with a target below 140 mm Hg (usual control) in nondiabetic patients with hypertension.

In total, 1111 nondiabetic patients aged 55 years or older with a systolic blood pressure of 150 mm Hg or higher were recruited from 44 centres in Italy between 2005 and 2007. Patients were randomly assigned to a target systolic blood pressure of less than 140 mm Hg (553) or less than 130 mm Hg (558). Antihypertensive drugs were used to lower bloodpressure and tailored to individual patients needs. Blood pressure was checked every 4 months for 2 years and at the final 2year visit patients were tested for LVH.

Over 2 years, tight (