The following Expert Roundtable Discussion was held on August 8, 2009. Dr. Clive Rosendorff from Mount Sinai School of Medicine moderated the topic "Lower Blood Pressure Targets: How Low Is Too Low?" with Drs. Franz Messerli from Columbia University College of Physicians and Surgeons and Steven Nissen from the Cleveland Clinic participating.
The medical community has known for a long time that lowering an elevated blood pressure decreases cardiovascular risk. Over the past two decades or so, published guidelines for hypertension management have proposed lower and lower blood pressure goals. The Expert Panel Discussion address the question: "Can blood pressure be reduced too much, perhaps to undesireable levels?" The theoretical limit to blood pressure lowering depends on the notion that the diastolic blood pressure is also the coronary perfusion pressure, and thus very low. Very low diastolic blood pressures may result in myocardial ischemia, particularly if there is LV hypertrophy or occlusive coronary disease. This situation would result in a slight increase in the cardiovascular risk at very low diastolic blood pressures which can be represented by a J-curve relationship. The experts' discussion focuses on answering the question of whether aggressively lowering blood pressure in hypertensive patients with coronary artery disease can be dangerous. The discussion addresses the evidence for this statement and whether this is actually a problem for patients. In addition, the experts venture opinions as to potential lower limits of acceptable diastolic blood pressure that the medical community could consider for their patients. (Med Roundtable Cardiovasc Ed. 2010;1(1):6–11) ©2010 FoxP2 Media, LLC