From the Guidelines
For individuals with hypertensive disease, the target blood pressure is generally below 130/80 mmHg, as recommended by the most recent guidelines 1. This represents a more stringent goal than the traditional 140/90 mmHg threshold, based on evidence that lower targets reduce the risk of cardiovascular events, stroke, and kidney disease.
Key Considerations
- The 2020 ACC/AHA hypertension guidelines emphasize the importance of accurate blood pressure measurement and individualized treatment targets 1.
- Lifestyle modifications, including reduced sodium intake, regular physical activity, weight management, limited alcohol consumption, and a diet rich in fruits and vegetables, are essential for managing hypertension.
- Medication options, such as thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers, may be necessary to achieve target blood pressure, with many patients requiring multiple medications.
Blood Pressure Monitoring
- Home blood pressure monitoring is recommended, with measurements taken at the same time daily, after 5 minutes of rest, with the arm supported at heart level 1.
- Blood pressure naturally fluctuates throughout the day, so consistent monitoring helps establish patterns and evaluate treatment effectiveness.
Individualized Treatment Targets
- 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.
- For those at lower risk for cardiovascular disease, a target of <140/90 mmHg may be suitable.
Overall, the management of hypertensive disease requires a comprehensive approach, incorporating lifestyle modifications, medication, and regular blood pressure monitoring to achieve optimal treatment targets and reduce the risk of cardiovascular complications.
From the Research
Normal Blood Pressure for Individuals with Hypertensive Disease
The concept of normal blood pressure can vary depending on several factors, including the presence of hypertensive disease. According to various studies, here are some key points to consider:
- The American and Canadian guidelines define hypertension as a blood pressure of 130/80 mmHg or higher 2.
- The European guidelines define hypertension as a blood pressure of 140/90 mmHg or higher 2.
- For individuals with diabetes mellitus, the target blood pressure is less than 130/80 mmHg 3.
- For individuals with cardiovascular or renal disease, the target blood pressure may be lower, typically less than 120/80 mmHg 4, 5.
- Lifestyle modifications, such as salt restriction and weight reduction, can help lower blood pressure in individuals with prehypertension (systolic blood pressure between 120 and 139 mmHg and/or diastolic pressures between 80 and 89 mmHg) 6.
- Pharmacological therapy may be indicated for some patients with prehypertension who have specific comorbidities, including diabetes mellitus, chronic kidney disease, and coronary artery disease 6.
Blood Pressure Targets
The optimal blood pressure target for individuals with hypertensive disease is a topic of ongoing debate. Some studies suggest that:
- Intensive blood pressure-lowering aimed at a systolic blood pressure of 120-130 mmHg can cause a significant reduction in cardiovascular morbidity and mortality 2.
- Lowering blood pressure to less than 120/80 mmHg may be beneficial for individuals with high cardiovascular risk 4, 5.
- However, there is also a risk of overtreatment with antihypertensive drugs, particularly in individuals at low cardiovascular risk 2.