What is the recommended blood pressure (BP) target for adults?

Blood Pressure Target for Adults with Hypertension

The recommended blood pressure target for most adults with hypertension is <130/80 mmHg, with treatment initiation at BP ≥130/80 mmHg for high-risk patients (those with known cardiovascular disease or 10-year ASCVD risk ≥10%) and ≥140/90 mmHg for lower-risk patients. 1

General BP Target

• After initiating antihypertensive therapy, the treatment goal is <130/80 mmHg regardless of ASCVD risk level 1
• The evidence supporting this target is strongest (Class I, high-quality evidence) for patients with known cardiovascular disease or 10-year ASCVD risk ≥10% 1
• For lower-risk adults without CVD and <10% 10-year ASCVD risk, the same <130/80 mmHg target may be reasonable but carries lower strength of recommendation (Class IIa) 1

Treatment Initiation Thresholds

The threshold for starting medication differs based on cardiovascular risk:

• High-risk patients (known CVD, 10-year ASCVD risk ≥10%, diabetes, CKD, or age ≥65 years): Initiate pharmacologic therapy at BP ≥130/80 mmHg 1
• Lower-risk patients (no CVD, <10% 10-year ASCVD risk): Initiate therapy at BP ≥140/90 mmHg 1

Special Populations

Older Adults (≥65 years)

• Target SBP <130 mmHg for noninstitutionalized, ambulatory, community-dwelling adults ≥65 years if tolerated 1
• Older adults are automatically considered high-risk (≥10% 10-year ASCVD risk), warranting treatment initiation at SBP ≥130 mmHg 1
• For those with high comorbidity burden and limited life expectancy, treatment decisions should be individualized using clinical judgment and team-based assessment 1
• Careful monitoring for orthostatic hypotension and adverse effects is essential, especially when initiating dual therapy 1

Diabetes Mellitus

• Initiate treatment at BP ≥130/80 mmHg with target <130/80 mmHg 1
• Most adults with diabetes and hypertension have ≥10% 10-year ASCVD risk, placing them in the high-risk category 1

Chronic Kidney Disease

• Initiate treatment at BP ≥130/80 mmHg with target <130/80 mmHg 1
• Patients with CKD are automatically assigned to high-risk category for ASCVD 1

Stable Ischemic Heart Disease

• Target BP <130/80 mmHg (Class I recommendation) 1
• Use guideline-directed medical therapy including beta-blockers, ACE inhibitors, or ARBs as first-line agents 1

Stage 2 Hypertension Management

• For stage 2 hypertension (BP >20/10 mmHg above target), initiate therapy with two antihypertensive agents from different classes 1
• Patients with BP ≥160/100 mmHg require prompt treatment, careful monitoring, and rapid upward dose adjustment 1

Important Caveats

Avoid Overly Aggressive Lowering

• While the 2024 European guidelines recommend an optimal SBP target of 120-129 mmHg 1, the ACC/AHA guidelines maintain <130/80 mmHg as the standard target 1
• The European Society of Hypertension 2023 guidelines specifically recommend against targeting BP <120/70 mmHg due to potential J-curve harm 1

Monitoring and Follow-up

• Monthly follow-up is required after initiating or adjusting therapy until BP control is achieved 1
• Once at goal, follow-up every 3-6 months is appropriate 1
• Systematic strategies including home BP monitoring, team-based care, and telehealth improve BP control 1

Treatment Tolerability

• The target should be achieved "if tolerated" - monitor for orthostatic hypotension, dizziness, weakness, and renal function deterioration 1
• In older or frail patients, achieving the best BP possible within the target range while avoiding adverse effects takes priority over strict numerical targets 1