What is the ideal blood pressure?

From the Guidelines

The ideal blood pressure for adults is generally considered to be 120/80 mmHg or lower, with a target of 130/80 mmHg or lower for most patients, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. The top number (120) represents systolic pressure when the heart contracts, while the bottom number (80) represents diastolic pressure when the heart relaxes between beats.

Key Points to Consider

• Blood pressure below 120/80 mmHg is classified as normal, while 120-129/<80 mmHg is considered elevated.
• Hypertension begins at 130/80 mmHg and becomes more severe as numbers increase.
• For most adults, maintaining blood pressure below 130/80 mmHg is recommended to reduce the risk of cardiovascular disease, stroke, and kidney problems.
• The 2024 ESC guidelines recommend targeting a blood pressure of <140/90 mmHg in all patients, and 130/80 mmHg or lower in most patients, provided that the treatment is well tolerated 1.
• The guidelines also suggest that treated systolic BP values in most adults be targeted to 120–129 mmHg, provided the treatment is well tolerated 1.

Lifestyle Modifications

To maintain healthy blood pressure, focus on:

• Regular physical activity (aim for 150 minutes of moderate exercise weekly)
• A balanced diet low in sodium and rich in fruits and vegetables (like the DASH diet)
• Limiting alcohol consumption
• Avoiding tobacco
• Maintaining a healthy weight
• Managing stress effectively These lifestyle modifications work by reducing vascular resistance, improving heart function, and promoting overall cardiovascular health.

Additional Considerations

• Blood pressure naturally fluctuates throughout the day based on activity, stress, and other factors.
• The optimal diastolic blood pressure target is 70–79 mmHg, as recommended by the 2024 ESC guidelines 1.
• For persons with elevated BP, treatment with lifestyle measures for 3 months is first recommended, prior to considering medications 1.

From the Research

Ideal Blood Pressure

The ideal blood pressure is a topic of ongoing debate, with various guidelines and studies providing different recommendations.

• The American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document recommends a blood pressure of less than 140/90 mmHg in adults aged 60-79 years and a systolic blood pressure of 140 to 145 mmHg if tolerated in adults aged 80 years and older 2.
• The 2017 ACC/AHA hypertension guidelines recommend a systolic BP between 120-129 mmHg with a diastolic BP less than 80 mmHg for lifestyle measures, and treatment with lifestyle measures plus BP lowering drugs for secondary prevention of cardiovascular events in persons with clinical cardiovascular disease and an average systolic BP of ≥130 mmHg or an average diastolic BP≥80 mmHg 3.
• The Canadian guidelines define normal blood pressure as less than 140/90 mmHg, while the AHA and ESC estimate normal blood pressure to be less than 120/80 mmHg 4.
• A study published in 2013 recommends a systolic blood pressure goal of <140 mmHg in patients less than 80 years of age and a systolic blood pressure goal of 140-150 mmHg in patients 80 years of age or older 5.
• The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure redefined normal blood pressure as less than 120/80 mm Hg in 2003, and added the category of prehypertension 6.

Blood Pressure Goals by Age

• For adults aged 60-79 years, a blood pressure of less than 140/90 mmHg is recommended 2, 5.
• For adults aged 80 years and older, a systolic blood pressure of 140 to 145 mmHg if tolerated is recommended, with a target goal of less than 140/90 mmHg considered in those with diabetes mellitus or chronic kidney disease 2.
• For adults with diabetes mellitus or chronic kidney disease, a blood pressure of less than 140/90 mmHg is recommended 2, 5.

Measurement and Treatment

• Automated validated devices should be used for measuring blood pressure 3.
• Treatment with lifestyle measures plus BP lowering drugs is recommended for secondary prevention of cardiovascular events in persons with clinical cardiovascular disease and an average systolic BP of ≥130 mmHg or an average diastolic BP≥80 mmHg 3.
• Initiation of antihypertensive drug therapy with 2 first-line drugs from different classes is recommended in persons with a BP ≥140/90 mmHg or with a BP > 20/10 mmHg above their BP target 3.