From the Guidelines
To score resting hypertension (HTN), I recommend using a blood pressure threshold of 130/80 mmHg, as defined by the 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline 1.
Key Points to Consider
- The American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline also recommends a blood pressure threshold of 130/80 mmHg for diagnosing hypertension 1.
- The classification of hypertension is based on cutoff values, which may be arbitrary, but simplifies diagnostic and treatment approaches in daily practice 1.
- The threshold for hypertension should be considered flexible, based on the level and profile of total cardiovascular risk of each individual 1.
Diagnosis and Assessment
- Resting hypertension can be diagnosed using 24-hour ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring 1.
- Patients should avoid caffeine, exercise, and smoking for at least 30 minutes before measurements to ensure accurate readings.
- Normally, blood pressure should decrease by 10-20% during sleep, and the absence of this pattern is associated with increased cardiovascular risk.
Treatment Decisions
- Identifying resting hypertension is important for treatment decisions, as it may require adjusting medication timing or selecting specific antihypertensive agents that provide 24-hour coverage.
- The 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline provides a clear picture of the evidence related to the treatment and management of patients with high blood pressure 1.
From the Research
Definition of Resting Hypertension
- Resting hypertension is defined as a persistent systolic blood pressure (SBP) of at least 130 mm Hg or diastolic blood pressure (DBP) of at least 80 mm Hg 2.
- The American College of Cardiology and American Heart Association recommend a blood pressure level goal of less than 130/80 mm Hg for adults with confirmed hypertension and without additional markers of increased atherosclerotic cardiovascular disease (ASCVD) risk 3.
Blood Pressure Targets
- The target blood pressure for most adults is less than 130/80 mm Hg 2, 3.
- For adults with diabetes mellitus or chronic kidney disease, the target blood pressure is less than 130/80 mm Hg 4, 5.
- For adults older than 60 years, the evidence for reducing systolic blood pressure to less than 150 mm Hg is good, but the evidence in younger adults is insufficient to recommend a specific goal 4.
Lifestyle Modifications
- Lifestyle modifications, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption, are recommended for the management of hypertension 2, 3, 4, 5, 6.
- The Dietary Approaches to Stop Hypertension (DASH) diet, sodium restriction, and regular exercise are associated with improvements in blood pressure 3, 4, 6.