‘Treat to target’: moving targets from hypertension, hyperlipidaemia and diabetes to rheumatoid arthritis
- 1Department of Cardiology, Oslo University Hospital, Aker and Ullevål, Oslo, Norway
- 2Faculty of Medicine, University of Oslo, Oslo, Norway
- 3Department of Endocrinology, Oslo University Hospital, Oslo, Norway
- 4Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Correspondence to Professor Dan Atar, Department of Cardiology, Division of Medicine B, Oslo University Hospital, Kirkeveien 166, Oslo 0407, Norway;
- Accepted 2 February 2010
The principle of ‘treat to target’ embraces an indispensable approach to the prevention of some of the most prevalent diseases: diabetes, arterial hypertension and coronary heart disease. These highly ubiquitous disorders account for most deaths and disabilities worldwide. Preventive treatment is thus a matter of paramount priority.
How did ‘treat to target’ come about? The rationale for this therapeutic paradigm is based on a comprehensive evidence base that is—fair to say—unique to cardiovascular medicine. Few areas in contemporary medicine have investigated hundreds of thousands of patients with a given condition just to scrutinise one particular therapeutic intervention, such as the lowering of blood pressure with a given agent, or such as low-density lipoprotein (LDL)-cholesterol lowering by a statin.
What do we mean by ‘comprehensive evidence base’? Clinical trials demonstrate that to reduce cardiovascular events in individuals with hypertension, blood pressure lowering (eg, to <150/100 mm Hg) is effective, and more intensive blood pressure lowering (eg, to <140/90 mm Hg) is more effective.1 Likewise, to reduce cardiovascular events in patients with established ischaemic heart disease through lipid lowering, a statin is more effective than placebo, aggressive statin therapy is more effective than lenient statin therapy, and in patients receiving aggressive statin therapy the lowest risk is associated with the lowest LDL-cholesterol levels.2 This preventive treatment strategy aiming at lowering LDL-cholesterol has been coined as the concept of ‘the lower the better’. Incidentally, the aphorism ‘the lower the better’ is just a linguistic corollary to the dictum ‘treat to target’. Taken together, this evidence base essentially teaches us that treating patients to goal confers the …