From the Guidelines
For individuals with hypertensive heart disease, the target blood pressure is generally below 130/80 mmHg. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of maintaining blood pressure within this range to reduce the workload on the heart, prevent further cardiac damage, and lower the risk of additional cardiovascular events such as heart attacks and strokes 1.
Key Considerations
- The definition of normal blood pressure remains the same as in previous guidelines, with an average systolic BP <120 mm Hg and average diastolic BP <80 mm Hg 1.
- The 2017 American College of Cardiology/American Heart Association hypertension guideline replaces the term “prehypertension” with “elevated BP” and introduces “stage 1 hypertension” for individuals with an average SBP of 130 to 139 mm Hg or average DBP of 80 to 89 mm Hg 1.
- Recent randomized clinical trials have demonstrated benefits with an SBP below 130 mm Hg, supporting the new classification and treatment targets 1.
Treatment Approach
- Treatment typically involves a combination of lifestyle modifications and medications.
- Lifestyle changes include:
- Reducing sodium intake to less than 2,300 mg daily
- Regular physical activity (at least 150 minutes of moderate exercise weekly)
- Weight management
- Limiting alcohol consumption
- Following a heart-healthy diet like DASH (Dietary Approaches to Stop Hypertension)
- Medication regimens often include ACE inhibitors, ARBs, calcium channel blockers, or diuretics, with dosages individualized based on response and tolerance.
Monitoring and Adjustment
- Regular monitoring of blood pressure at home and during medical visits is essential to ensure treatment effectiveness and make necessary adjustments.
- The use of out-of-office BP measurements, such as ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM), is recommended to confirm the diagnosis of hypertension and titrate medication 1.
From the FDA Drug Label
The goal blood pressure was <140/90 mmHg At the end of study or at the last visit before a primary endpoint, the mean blood pressures were 144.1/81.3 mmHg for the group treated with losartan potassium and 145.4/80. 9 mmHg for the group treated with atenolol
The normal blood pressure for individuals with hypertensive heart disease is considered to be less than 140/90 mmHg.
- Systolic blood pressure: less than 140 mmHg
- Diastolic blood pressure: less than 90 mmHg 2
From the Research
Definition of Normal Blood Pressure
- Normal blood pressure is typically defined as a systolic pressure of less than 120 mmHg and a diastolic pressure of less than 80 mmHg 3.
- However, the American College of Cardiology/American Heart Association (ACC/AHA) defines hypertension as a blood pressure of 130/80 mmHg or higher 4, 5.
Blood Pressure Targets for Hypertensive Heart Disease
- The optimal blood pressure target for individuals with hypertensive heart disease is a topic of debate, with some studies suggesting that a target of less than 130/80 mmHg is effective in lowering blood pressure and preventing cardiovascular disease 5.
- Other studies suggest that a more personalized approach to blood pressure management is necessary, taking into account individual risks, benefits, and preferences 4.
- A blood pressure of 115/75 mmHg is associated with minimal vascular mortality and is considered optimal, but this level is infrequently achieved in westernized societies 6.
Considerations for Blood Pressure Management
- Lifestyle modifications, such as diet and exercise, can help lower blood pressure and reduce the risk of cardiovascular disease 3, 6.
- Medication adherence and polypharmacy are important considerations in blood pressure management, and a personalized approach to treatment is necessary to minimize risks and maximize benefits 4, 7.
- The use of thiazide diuretics, such as chlortalidone or hydrochlorothiazide, is often recommended as a first-line treatment for hypertension, but other classes of antihypertensive drugs may also be effective 7.