Updating blood pressure (BP) target goals for each individual patient may be the most effective way to deliver high-quality care, according to new research published in the Journal of the American College of Cardiology.

“Our results suggest that BP targets may need to be modified depending on the cardiovascular (CV) outcome for which the patient is most at risk,” said lead author Nathan K. Itoga, MD, a specialist at Stanford University School of Medicine, and colleagues. “For example, for a given person with history of a previous stroke, more aggressive BP lowering may be warranted given the linear association seen, whereas for the person with a history of previous myocardial infarction (MI), care would need to be taken to avoid excessive diastolic blood pressure (DBP) lowering.”

The authors tracked data from ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), a study that enrolled patients from February 1994 to March 2002. In the analysis, during a median follow-up of 4.4 years, 33,357 patients had 2,636 MIs.

Fifty-three percent of patients were men, and the mean patient age was 67.4 years old.

The cohort was randomized to chlorthalidone, amlodipine, or lisinopril therapy with a target BP of <140/90 mm Hg.

The primary composite outcome was time from randomization to the first incidence of MI, stroke, congestive heart failure (CHF), or all-cause mortality.

In addition to the reported MIs, there were 866 CHF events, 936 strokes, and 3,700 deaths.