What are the target blood pressure parameters and medications for blood pressure control?

From the Guidelines

The target blood pressure for most adults should be less than 130/80 mmHg, with a treated systolic BP value targeted to 120–129 mmHg if well tolerated, as recommended by the most recent guidelines 1.

Key Considerations for Blood Pressure Control

• The first objective of treatment should be to lower BP to <140/90 mmHg in all patients, and then target 130/80 mmHg or lower if well tolerated 1.
• Blood pressure targets should be individualized through a shared decision-making process that addresses cardiovascular risk, potential adverse effects of antihypertensive medications, and patient preferences 1.
• For individuals with diabetes and hypertension at higher cardiovascular risk, a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained 1.

Medications for Blood Pressure Control

• First-line medications include thiazide diuretics, calcium channel blockers, ACE inhibitors, and ARBs 1.
• Treatment typically begins with a single agent at a low dose, with dose adjustments every 2-4 weeks until target blood pressure is achieved.
• Many patients require two or more medications for adequate control, with dual therapy recommended as first-line treatment 1.
• ACE inhibitors or ARBs are preferred in patients with diabetes or chronic kidney disease 1.

Lifestyle Modifications

• Reducing sodium intake, maintaining a healthy weight, regular exercise, limiting alcohol, and following a DASH diet are essential lifestyle modifications alongside medication 1.
• Patients with diabetes on combined antihypertensive treatments should be encouraged to self-monitor BP 1.

From the FDA Drug Label

If goal blood pressure (<140/90 mmHg) was not reached, hydrochlorothiazide (12.5 mg) was added first and, if needed, the dose of losartan or atenolol was then increased to 100 mg once daily. The target blood pressure parameters are less than 140/90 mmHg. The medications for blood pressure control mentioned are:

• Losartan: initial dose of 50 mg once daily, increased to 100 mg once daily if needed
• Atenolol: initial dose of 50 mg once daily, increased to 100 mg once daily if needed
• Hydrochlorothiazide: initial dose of 12.5 mg, increased to 25 mg if needed 2
• Lisinopril: dose range of 20 mg to 80 mg daily 3

From the Research

Target Blood Pressure Parameters

• The target blood pressure parameters vary depending on the guidelines and patient population. According to the study 4, the US defines hypertension as > 130/80 mmHg, while other guidelines define it as > 140/90 mmHg.
• The American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document recommends reducing blood pressure to less than 140/90 mmHg in adults aged 60-79 years and to 140-145 mmHg in adults aged 80 years and older 5.
• The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines propose a blood pressure target of < 130/80 mmHg across all age groups 6.

Medications for Blood Pressure Control

• The study 7 suggests that adding an ACE inhibitor to a beta-blocker may be as effective as adding a diuretic in patients who fail to respond to monotherapy with a beta-blocker.
• The study 8 found that aggressive antihypertensive therapy based on hydrochlorothiazide, candesartan, or lisinopril can decrease left ventricular mass and improve arterial compliance in patients with type II diabetes mellitus and hypertension.
• The choice of medication may depend on the patient's individual characteristics, such as the presence of diabetes or chronic kidney disease, and the specific guidelines being followed 4, 5, 6.

Lifestyle Modification and Patient Adherence

• All guidelines emphasize the importance of lifestyle modification, including diet and exercise, as the cornerstone of initial therapy for blood pressure control 4, 5.
• Patient adherence to medication and lifestyle modification is crucial for maintaining blood pressure control 4, 5, 6.