What is the rule of 40 in hypertension (high blood pressure)?

From the Guidelines

The Rule of 40 in hypertension is not directly mentioned in the provided evidence, however, it is crucial to understand that the current guidelines prioritize absolute cardiovascular risk and blood pressure thresholds to determine the need for treatment. When considering the management of hypertension, it's essential to focus on the most recent and highest quality studies, such as the 2020 ACC/AHA hypertension guidelines 1. According to these guidelines, hypertension is diagnosed when blood pressure is consistently ≥130 and/or ≥80 mm Hg, and treatment is initiated based on the patient's risk profile. Some key points to consider in the management of hypertension include:

• The diagnosis of hypertension and the decision to initiate treatment are based on blood pressure thresholds and absolute cardiovascular risk.
• High-risk individuals, such as those with age 65 and older, diabetes, chronic kidney disease, or known cardiovascular disease, initiate drug therapy when BP ≥ 130/80 mm Hg.
• Non-high risk individuals initiate drug therapy when BP is ≥140/90 mm Hg.
• The target BP is minimally <130/80 mm Hg in most patients, with a systolic target of <130 mm Hg in those 65 and older.
• Treatment should be initiated with two drugs having complementary mechanisms of action when blood pressure is >20/10 mm Hg above goal, as stated in the guidelines 1. It's also important to note that while the Rule of 40 is not explicitly mentioned in the provided evidence, the guidelines do emphasize the importance of accurate blood pressure measurement and appropriate treatment to prevent end-organ damage. In clinical practice, the goal is to balance the risks of hypertensive damage against those of overly aggressive treatment, and to prioritize the patient's overall morbidity, mortality, and quality of life. Therefore, when managing hypertension, it is essential to follow the most recent guidelines and prioritize individualized treatment based on the patient's risk profile and blood pressure thresholds.

From the Research

Definition of Rule of 40 in Hypertension

There is no direct mention of the "rule of 40" in the provided studies.

Blood Pressure Targets

• The optimal target blood pressure in the treatment of hypertension is undefined, with some guidelines recommending ≤130/80 mm Hg for essentially all adults 2.
• Lower blood pressure targets (any target less than or equal to 135/85 mm Hg) do not reduce total mortality and total serious adverse events compared to standard blood pressure targets (less than or equal to 140/90 mm Hg) 3.
• Lower targets may reduce myocardial infarction and congestive heart failure, but this reduction is not reflected in total serious adverse events 3.

Treatment of Hypertension

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are both recommended as first-line antihypertensive agents for patients with diabetes 4.
• ACE inhibitors and ARBs have equal outcome efficacy, but ARBs have fewer adverse events 5, 6.
• Recent evidence suggests that ARBs may have neuroprotective effects compared to other antihypertensives, including ACE inhibitors, but this warrants further study 6.

Limitations

• The provided studies do not mention the "rule of 40" in hypertension, and therefore, there is limited information available on this topic.