What is the target blood pressure (BP)?

Target Blood Pressure Recommendations

For most adults with hypertension, the recommended target blood pressure is 120-129/70-79 mmHg, provided the treatment is well tolerated. 1

General Blood Pressure Targets

The 2024 European Society of Cardiology (ESC) guidelines provide the most recent evidence-based recommendations for blood pressure management:

• Initial goal: Lower BP to <140/90 mmHg in all patients 1
• Optimal target: 120-129/70-79 mmHg for most adults 1
• Diastolic target: <80 mmHg for all hypertensive patients 1

This approach represents a shift toward more intensive blood pressure control based on strong evidence that lower targets reduce cardiovascular disease risk.

Age-Specific Considerations

Blood pressure targets should be adjusted based on age:

• Adults <65 years: Target 120-129/<80 mmHg 1
• Older adults (≥65 years): Target 130-139/<80 mmHg 1
• Very elderly (≥85 years): Consider more lenient target (<140/90 mmHg) 1

Special Populations

High-Risk Patients

For patients with established cardiovascular disease, diabetes, chronic kidney disease, or 10-year cardiovascular risk ≥10%:

• Maintain strict adherence to the 120-129/<80 mmHg target 1
• For CKD patients with albuminuria, aim for <130/80 mmHg 2

Frail Patients

For patients with moderate-to-severe frailty or limited life expectancy (<3 years):

• Consider more lenient targets (<140/90 mmHg) 1
• Prioritize avoiding adverse effects from treatment 1, 2

Patients with Orthostatic Hypotension

• Consider more lenient targets (<140/90 mmHg) 1
• Monitor for symptoms of hypotension 2

Implementation Strategy

1. Initial approach: Start with lifestyle modifications for all patients with elevated BP
2. First medication target: Achieve <140/90 mmHg in all patients 1
3. Optimal target: Further titrate to 120-129/70-79 mmHg if well tolerated 1
4. Monitoring:
   • Check BP regularly using standardized measurement techniques
   • Monitor for adverse effects, especially in elderly patients
   • Check electrolytes and kidney function 1-2 weeks after initiating or adjusting medications 2

Important Caveats

• Avoid excessive lowering: Diastolic BP should generally not be <70 mmHg, especially in patients with coronary artery disease 2
• Medication selection: Use ACE inhibitors, ARBs, calcium channel blockers, or thiazide/thiazide-like diuretics as first-line agents 1, 3
• Treatment resistance: For uncontrolled BP on three medications, add spironolactone 1
• J-curve phenomenon: While some observational data suggest potential harm with very low BP, randomized trials support the benefits of the recommended targets 1

The 2024 ESC guidelines represent the most current evidence-based approach, emphasizing that for most adults, a target BP of 120-129/70-79 mmHg provides the optimal balance between cardiovascular risk reduction and treatment tolerability.