Benefits of antihypertensive drugs when blood pressure is below 140/90 mmHg

Antihypertensive medications are used to lower blood pressure (BP) but, ultimately, their true value lies in reductions in morbidity and mortality (cardiovascular, cerebrovascular, and renal diseases). Hypertension is defined discreetly (generally 140/90 mmHg) but the actual relationship between BP and adverse cardiac and cerebrovascular outcomes is continuous. Observational studies have demonstrated a powerful log‑linear relationship between BP and mortality due to ischemic heart disease (IHD) or stroke over the range of 115/75 to 185/115 mmHg. Clinical trials and meta-analyses have clearly demonstrated benefits of antihypertensive drugs in nonhypertensive individuals: delay or prevention of the onset of hypertension and microalbuminuria and reduced morbidity and mortality from IHD, stroke, and chronic kidney disease. This is not surprising given that various antihypertensive drug classes have multiple potential beneficial effects. A persistent concern is that overtreatment of hypertension may increase risk in individuals with coronary artery disease, but a “J-curve” effect is not consistently found in clinical studies. The use of antihypertensive drugs in at‑risk individuals who are below the traditional threshold (140/90 mmHg) is fully justifiable, but the decision requires adequate clinical experience and judgment and a full assessment of risks and benefits.