What should be the blood pressure (BP) goal for people with hypertension (HTN)?

Blood Pressure Goals for Hypertension Management

The blood pressure goal for people with hypertension should be less than 130/80 mmHg to maximize reduction in cardiovascular morbidity and mortality. 1, 2

General Population Blood Pressure Targets

• For most adults with hypertension, the target blood pressure should be <130/80 mmHg 1
• This recommendation represents a shift from previous guidelines that recommended <140/90 mmHg as the standard target 1
• The more aggressive target is based on evidence showing significant reduction in cardiovascular events with lower blood pressure targets 2

Special Population Considerations

Patients with Comorbidities

• Chronic Kidney Disease: BP goal <130/80 mmHg 1, 2
• Diabetes: BP goal <130/80 mmHg 1, 2
• Heart Failure with Preserved Ejection Fraction: SBP <130 mmHg 1
• Stable Ischemic Heart Disease: BP <130/80 mmHg 1
• Post-Kidney Transplantation: BP <130/80 mmHg 1

Age Considerations

• For older adults who can tolerate treatment, the same target of <130/80 mmHg is recommended 2
• However, treatment should be carefully monitored in frail elderly patients to avoid adverse effects 2, 3

Stepped Approach to BP Management

A practical approach to hypertension management includes:

1. Initial Target: First achieve BP <140/90 mmHg in all patients 2, 3
2. Optimal Target: Then aim for <130/80 mmHg if well-tolerated 2
3. Caution Zone: Avoid reducing BP below 120/70 mmHg as this may increase risk of adverse events 3

Treatment Strategy

• First-line therapy: Lifestyle modifications (weight loss, sodium restriction, DASH diet, physical activity, alcohol moderation) 4
• Pharmacologic therapy:
  • Thiazide diuretics
  • ACE inhibitors or ARBs
  • Calcium channel blockers 1, 2, 4

Monitoring and Follow-up

• Regular BP monitoring both in office and at home
• Assess for medication side effects and adherence
• Follow-up within 2-3 weeks of medication changes to evaluate efficacy 2
• Monitor renal function and electrolytes, especially in patients on ACE inhibitors, ARBs, or diuretics 2

Common Pitfalls to Avoid

• Therapeutic inertia: Failing to intensify treatment when BP remains above goal
• Ignoring home BP readings: Office readings alone may miss masked hypertension 5
• Excessive BP lowering: Watch for signs of organ hypoperfusion (orthostatic hypotension, dizziness, worsening renal function) 2, 3
• Neglecting comorbidities: Different conditions may require specific antihypertensive agents 2

The evidence strongly supports that achieving a BP target of <130/80 mmHg provides significant cardiovascular protection for most patients with hypertension. While this more aggressive target represents a shift from older guidelines, it is supported by recent high-quality evidence and multiple guideline bodies including the American College of Cardiology and American Heart Association 1.