From the Guidelines
The risk of stroke increases significantly at a blood pressure of 130/80 mmHg, and efforts should be made to maintain blood pressure below this threshold to minimize stroke risk. According to the most recent guidelines, a blood pressure of 130/80 mmHg or higher is considered hypertension, and individuals with this level of blood pressure are at increased risk of stroke and other cardiovascular events 1. The relationship between blood pressure and stroke risk is continuous, meaning that even small increases in blood pressure can incrementally raise stroke risk.
Key Points to Consider
- Maintaining a blood pressure below 120/80 mmHg is ideal for minimizing stroke risk
- For most adults, blood pressure should be kept below 130/80 mmHg to reduce cardiovascular risks, including stroke
- Lifestyle changes such as reducing salt intake, increasing physical activity, maintaining a healthy weight, and limiting alcohol consumption can help lower blood pressure
- Medication may be prescribed to lower blood pressure effectively in some cases
Evidence-Based Recommendations
The 2017 ACC/AHA Guideline recommends a blood pressure goal of <130/80 mmHg for adults with a 10-year atherosclerotic CVD risk ≥10% 1. This guideline is based on evidence from multiple randomized clinical trials, including the PREVER-Prevention Trial and the Systolic BP Intervention Trial (SPRINT), which showed reduced CVD events and death with a goal blood pressure <130/80 mmHg.
Clinical Implications
If your blood pressure consistently reads 140/90 mmHg or higher, it's essential to consult with a healthcare provider immediately. They may recommend lifestyle changes or medication to lower blood pressure effectively. The American College of Cardiology (ACC)/American Heart Association (AHA) guideline has been embraced by most professional societies with an interest in blood pressure and by US governmental agencies, including the National Center for Health Statistics (NCHS) 1.
From the Research
Blood Pressure and Stroke Risk
The relationship between blood pressure (BP) and stroke risk is strong and continuous, with the higher the BP, the greater the risk of stroke 2.
Target Blood Pressure Levels
- The target BP should be < 140/90 mmHg for patients with hypertension 2, 3.
- A lower target BP of < 130/80 mmHg may be beneficial for patients with lacunar infarction, those taking antithrombotic drugs, cerebral hemorrhage, and subarachnoid hemorrhage 2, 4.
- In the acute phase of ischemic stroke, BP should only be actively lowered at values over 220/120 mmHg 5, 3.
- For patients with high cardiovascular risk, reducing BP consistently to < 140/90 mmHg had marked beneficial effects, while reducing BP to < 130/80 mmHg led only to some possible further benefit on stroke 6.
Blood Pressure Management
- Regular BP screening and appropriate treatment of patients with hypertension, including lifestyle modification and pharmacotherapy, are recommended 2.
- The selection of BP management strategies should be guided by the risk of recurrent ischemic and hemorrhagic strokes 4.
- A stepped-care approach for cautious BP lowering (usually to levels < 140/90 mmHg) is preferred for patients with severe diseases of the major cerebral vessels, who have a high risk of recurrent ischemic stroke 4.