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The treatment of essential hypertension has improved dramatically during the past 50 years. However, even optimally treated hypertensives still have considerable residual cardiovascular risk (see below), and this residual risk exerts a huge impact overall because essential hypertension is such a common disease.With regard to residual risk, an optimally treated hypertensive patient still has a 50% increased risk of a cardiovascular event even after correcting for systolic blood pressure, that is, a treated hypertensive is at 50% greater cardiovascular risk than an untreated normotensive with the same systolic BP.1 When the cardiovascular risk in treated hypertension is broken down further, the increased risk of stroke, coronary disease, and cardiovascular death are 75%, 46%, and 62%, respectively. Many other studies have found the same increased residual cardiovascular risk in treated hypertension.2–7 Intriguingly, the higher the pretreatment cardiovascular risk is the greater the absolute risk reduction when BP is reduced and yet the higher also is the residual risk.8 Whatever the cause of this residual risk in hypertension, we ought to strive to find novel therapeutic strategies against it because this extra residual risk (50%) applies to >50% of all individuals aged ≥60 years in a population (ie, all the hypertensives). In other words, the scale of this problem is such that reducing residual risk, even modestly, could markedly reduce cardiovascular events/mortality overall and, thereby have an enormous impact on a population’s health and healthcare costs.The most obvious strategy that has been attempted to reduce residual risk was to try setting a lower target BP than the current one. However, attempts to do this have been disappointing. The best example of this is the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study.9 We therefore need a better strategy to tackle this problem than …

High B-Type Natriuretic Peptide Hypertensives at Target Blood Pressure