Unanswered Questions Regarding Blood Pressure Management for HF Prevention.

PURPOSE OF REVIEW: Evaluate the relevant new findings regarding hypertension treatment and heart failure prevention published in the past 3 years.

RECENT FINDINGS: In a recent secondary analysis of Systolic Blood Pressure Intervention Trial (SPRINT), randomization of more than 9000 patients > 50 years old with high cardiovascular risk but without diabetes to intensive treatment targeting blood pressure < 120/80 mmHg compared to standard treatment targeting < 140/90 mmHg significantly reduced incident heart failure. While such benefits outweighed potential harm, adverse events including renal dysfunction, hypotension, and syncope occurred more frequently with intensive treatment. Following SPRINT, existing guidelines differ in their recommendations and controversies still exist. Key persistent questions include the role of intensive treatment in younger adults and those at lower cardiovascular risk and optimal approaches to translate clinical trial findings into clinical practice in a sustainable fashion. Aggressively treating hypertension to targets below 120/80 mmHg prevents heart failure in high-risk patients. However, evidence is lacking to younger patients and those at lower cardiovascular risk.