What is the ideal blood pressure?

From the Guidelines

The ideal blood pressure target is less than 130/80 mmHg for patients with diabetes, with a systolic blood pressure goal of 130 mmHg and a diastolic blood pressure goal of less than 80 mmHg, as recommended by the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases 1.

Key Considerations

• The blood pressure target may vary depending on individual cardiovascular risk, with a target of <130/80 mmHg recommended for those at higher risk and <140/90 mmHg for those at lower risk 1.
• Optimal blood pressure control reduces the risk of micro- and macrovascular complications, and guidance on lifestyle changes must be provided for patients with diabetes and hypertension 1.
• Blood pressure control often requires multiple drug therapy with a renin-angiotensin-aldosterone system (RAAS) blocker, and a calcium channel blocker or diuretic, with dual therapy recommended as first-line treatment 1.

Important Notes

• Patients with diabetes and hypertension should monitor their blood pressure at home, and blood pressure targets should be individualized through a shared decision-making process that addresses cardiovascular risk, potential adverse effects of antihypertensive medications, and patient preferences 1.
• Regular monitoring is essential, as hypertension often has no symptoms but can lead to serious health problems like heart disease, stroke, and kidney damage if left untreated.
• The combination of an ACEI and an ARB is not recommended, and evidence strongly supports the inclusion of an angiotensin-converting enzyme inhibitor (ACEI), or an angiotensin receptor blocker (ARB) in patients who are intolerant to ACEI 1.

From the Research

Ideal Blood Pressure Targets

The ideal blood pressure target is a topic of ongoing debate, with various studies suggesting different thresholds. Some key points to consider include:

• The American Heart Association recommends a target blood pressure of ≤130/80 mm Hg for essentially all adults 2.
• A study published in the Korean Circulation Journal suggests that intensive blood pressure lowering to achieve a target BP below 130/80 mmHg is beneficial in reducing CV outcomes, but caution should be exercised to avoid adverse events 3.
• Another study published in Advances in Experimental Medicine and Biology recommends a target systolic BP of less than 140 mmHg if BP is measured by classic auscultatory method, and less than 120 mmHg in high-risk patients if BP is measured by automated office BP measurement 4.
• A review of calcium channel blockers and their use in treating hypertension suggests that the primary goal in the treatment of hypertension is to reduce overall blood pressure to below 140/90 mmHg, with a more optimal goal of 130/80 mmHg 5.

Factors to Consider

When determining the optimal blood pressure target for an individual patient, several factors should be considered, including:

• Age: elderly patients may require different targets than younger patients 4.
• Frailty: patients with frailty may require more cautious blood pressure management 2.
• Polypharmacy: patients taking multiple medications may require closer monitoring of blood pressure 2.
• Baseline blood pressure: patients with higher baseline blood pressures may require more intensive treatment 4.
• Diastolic blood pressure: a diastolic blood pressure of less than 70 mmHg may be associated with an increased risk of ischemic heart events 4.

Blood Pressure Targets in Specific Populations

Different populations may require different blood pressure targets, including:

• Diabetic patients: a target systolic BP of less than 140 mmHg is recommended 4.
• Patients with protein-creatinine ratio >500 mg/g: a lower SBP target of <130 mmHg may be proposed for renal protection 4.
• Patients at low or intermediate risk: treatment should start when SBP is above 140 mmHg, and target BP should be less than 140 mmHg 4.