[Blood pressure: the lower the better? Maybe no].

Antihypertensive treatment is aimed at reducing as much as possible health outcomes in terms of morbidity and mortality. The main international guidelines and clinical trials showed different positions about blood pressure targets. At present, there is no common opinion about the benefits of an aggressive drug treatment; moreover it is not clear whether lower blood pressure values are related to increased morbidity and mortality. The recent randomized SPRINT trial has compared intensive vs standard drug therapy in a non-diabetic hypertensive population. The trial has shown benefits of intensive treatment in reducing important health outcomes, though results were not confirmed in several patient subsets. We examined the studies on hypertensive patients with comorbidities (i.e., chronic kidney disease, cardiovascular disease) to identify blood pressure targets recommended in these populations, but no strong evidence was found about the benefits of intensive treatment. In geriatric patients the "lower is better" paradigm cannot be entirely applied because of comorbidity, polypharmacy and frailty.