What is the target blood pressure (BP) as per National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary (CKS)?

NICE CKS Blood Pressure Targets

According to NICE (National Institute for Health and Care Excellence) Clinical Knowledge Summary, the target blood pressure is below 140/90 mmHg for most adults with hypertension, and below 150/90 mmHg for adults aged 80 years and older. 1

Standard Target for Most Adults

• For patients aged 60-79 years: Target BP <140/90 mmHg 1
• This target applies to the general hypertensive population without specific high-risk features 1
• The target should be achieved within 3 months of initiating therapy 1

Age-Specific Targets

Elderly Patients (≥80 years)

• Target BP <150/90 mmHg for adults aged 80 years and older 1
• This higher target for elderly patients is based largely on data from the HYVET study and acknowledges the potential risks of aggressive blood pressure lowering in this population 1
• This recommendation aligns with several international guidelines that support similar thresholds for older adults 1

Measurement and Monitoring Considerations

• Blood pressure should be measured accurately using validated devices with appropriate cuff sizes 1
• For diagnosis and monitoring, consider using ambulatory or home blood pressure monitoring to confirm office readings 1
• Avoid treating to excessively low targets in elderly patients, which may increase risk of falls and adverse events 1

Comparison with Other Guidelines

It is important to note that NICE targets differ from some other international guidelines:

• The American College of Cardiology/American Heart Association (ACC/AHA) recommends a more aggressive target of <130/80 mmHg for all adults with hypertension 1
• The International Society of Hypertension (ISH) also recommends <130/80 mmHg 1
• However, NICE maintains its evidence-based approach with the <140/90 mmHg target for most adults and <150/90 mmHg for those ≥80 years 1

Treatment Approach

• Initial therapy should include lifestyle modifications for all patients 1
• For pharmacological therapy, NICE recommends starting with ACE inhibitors/ARBs, calcium channel blockers, or thiazide diuretics depending on patient characteristics 1
• For patients not at target with a three-drug combination, consider adding spironolactone as a fourth agent 1

Common Pitfalls to Avoid

• Do not account for white coat hypertension or masked hypertension when making treatment decisions without proper confirmation through ambulatory or home monitoring 1
• Avoid over-treating elderly patients to targets that are too aggressive for their age group 1