Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. New blood pressure control goals, more rational but facilitating therapeutic inertia? Carlos Escobar a , Vivencio Barrios b , F. Javier Alonso-Moreno c , Jose Luis Llisterri d , Gustavo C. Rodriguez-Roca e , Miguel Angel Prieto f , on behalf of the Working Group of Arterial Hypertension of the Spanish Society of Primary Care Physicians (Group HTA/SEMERGEN) and the PRESCAP 2010 investigators N ew guidelines for the management of arterial hypertension have been recently published [1]. One of the most important novelties is the updated blood pressure (BP) control targets according to the avail- able evidence. Thus, a SBP less than 140 mmHg in general hypertensive population, including those patients at higher risk (i.e. diabetes, history of stroke, ischemic heart disease or chronic kidney disease), has been recommended. More- over, in elderly patients a SBP between 140 and 150 mmHg has been recommended and in those less than 80 years old a target of more than 140 mmHg may be considered in selected patients. With regard to DBP goals, the guidelines recommend a target of less than 90 mmHg in the general population and less than 85 mmHg in diabetics [1]. What is the impact of these new targets in clinical practice? We recently published the evolution of BP control in Spain in the last decade in the primary care setting using the data from three cross-sectional studies (PRESCAP 2002, PRESCAP 2006 and PRESCAP 2010) [2]. In this study, that included a total of 36 235 patients (12 754 in PRESCAP 2002, 10 520 in PRESCAP 2006 and 12 961 in PRESCAP 2010), the proportion of patients who achieved BP goals (140/90 mmHg in the general population; <130/85 mmHg in PRESCAP 2002 and <130/80 mmHg in PRESCAP 2006 and PRESCAP 2010 for patients with diabetes, chronic kidney disease or cardiovascular disease) were 36.1, 41.4 and 46.3%, respectively (P < 0.0001). This was largely associated with the higher use of combined therapy (44, 56.6 and 63.6, respectively; P < 0.001) [2]. We have recalculated BP control rates of PRESCAP 2010 with the new BP targets. Thus, according to new 2013 recommendations, BP control improved in general popu- lation from 46.3 to 60.8% (P < 0.0001). In diabetics, BP control increased from 19.7 to 50.3%, P < 0.0001. In those patients aged 80 years or older, the proportion of patients who achieved BP targets increased from 40.8 to 77.2% (P < 0.0001). Although these data are encouraging, great efforts have been made to improve the management of patients with arterial hypertension, and this has been translated into a progressive improvement of BP control rates [3]. In fact, different strategies have been developed to improve patient and physician awareness about the relevance of attaining BP control, mainly through continuous medical education [3]. For instance, different studies have reported that both, general practitioners and specialist, frequently underesti- mate the cardiovascular risk of hypertensive population in daily clinical practice, mainly in very high-risk patients, and this resulted in an increase of therapeutic inertia [4,5]. However, through this continuous medical education, in which European guidelines have had a key role [6,7], BP control rates have improved in parallel with the higher use of combined therapy [2]. With all these data, one great concern about these new BP goals may be that physicians may relax and worsen therapeutic inertia. As a result, although these new BP goals are evidence-based, medical societies and physicians should be cautious in order to use antihypertensive therapy when necessary to achieve BP targets. ACKNOWLEDGEMENTS Conflicts of interest There are no conflicts of interest. REFERENCES 1. Mancia G, Fagard R, Narkiewicz k, Redon j, Zanchetti A, Bo ¨hm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management ofarterial hypertension of the European Society ofHypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31:1281–1357. 2. Llisterri JL, Rodriguez-Roca GC, Escobar C, Alonso-Moreno FJ, Prieto MA, Barrios V, et al., on behalf of the Working Group of Arterial Hypertension of the Spanish Society of Primary Care Physicians (Group HTASEMER- GEN); and the PRESCAP 2010 investigators. Treatment and blood pres- sure control in Spain during 2002–2010. J Hypertens 2012; 30:2425–2431. 3. Barrios V, Banegas JR, Ruilope LM, Rodicio JL. Evolution of blood pressure control in Spain. J Hypertens 2007; 25:1975–1977. 4. Barrios V, Escobar C, de la Figuera M, Ma ´rquez E. Perception of the cardiologists about the therapeutic inertia in the management of hypertension. Med Clin (Barc) 2009; 132:118–119. 5. Barrios V, Escobar C, Caldero ´ n A, Echarri R, Gonza ´lez-Pedel V, Ruilope LM, CONTROLRISK Investigators. Cardiovascular risk profile and risk stratification of the hypertensive population attended by general practitioners and specialists in Spain. The CONTROLRISK study. J Hum Hypertens 2007; 21:479–485. 6. Mancia G, De Backer G, Dominiczack A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25:1105–1187. 7. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-Euro- pean Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21:1011–1053. Journal of Hypertension 2013, 31:2462–2465 a Cardiology Department, Hospital La Paz, b Cardiology Department. Hospital Ramo ´ny Cajal, Madrid, c Primary Care Center Sillerı´a, Toledo, d Primary Care Center Ingeniero Joaquı´n Benlloch, Valencia, e Primary Care Center La Puebla de Montalban, Toledo and f Primary Care Center Vallobı´n-La Florida, Oviedo, Asturias, Spain Correspondence to Carlos Escobar, Cardiology Department, Hospital La Paz, Madrid, Spain. E-mail: escobar_cervantes_carlos@hotmail.com J Hypertens 31:2462–2465 ß 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. DOI:10.1097/HJH.0000000000000002 2462 www.jhypertension.com Volume 31  Number 12  December 2013 Correspondence