From the Guidelines
The target blood pressure for someone taking antihypertensive medications is generally below 130/80 mmHg for most adults, as recommended by the most recent guidelines 1.
Key Considerations
- For older adults (over 65), a slightly higher target of below 140/90 mmHg may be appropriate, especially if they experience side effects at lower readings.
- These targets should be individualized based on a person's overall health status, comorbidities, and tolerance to medications.
- For those with diabetes or chronic kidney disease, stricter control (below 130/80 mmHg) is typically recommended, as supported by recent studies 1.
Monitoring and Management
- When taking antihypertensives, it's essential to monitor your blood pressure regularly at home, take medications consistently at the same time each day, and report any side effects like dizziness, fatigue, or swelling to your healthcare provider.
- Blood pressure medications work through various mechanisms - some remove excess fluid (diuretics), others relax blood vessels (ACE inhibitors, ARBs, calcium channel blockers), or reduce heart rate and force of contraction (beta-blockers).
Lifestyle Modifications
- Lifestyle modifications remain crucial even when on medication, including:
- Reducing sodium intake
- Maintaining a healthy weight
- Regular physical activity
- Limiting alcohol
- Managing stress Recent guidelines from the American College of Cardiology/American Heart Association 1 and the European Society of Cardiology/European Society of Hypertension 1 support these recommendations, emphasizing the importance of individualized treatment targets and comprehensive management of hypertension.
From the Research
Target Blood Pressure for Someone Taking Antihypertensives
- The optimal blood pressure level for a patient on antihypertensive medication should maximize the patient's well-being and lower the risk for pressure-related cardiovascular-renal complications 2.
- The Sixth Report from the Joint National Committee (JNC VI) recommends goal BP levels lower than 130/85 mm Hg for hypertensive persons with diabetes, renal disease, or heart failure, and lower than 140/90 mm Hg for all other hypertensive individuals 2.
- More recent studies suggest that the target systolic BP should be 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 3.
- In diabetic patients, the SBP target should be less than 140 mmHg according to the ACCORD trial, but for patients with protein-creatinine ratio >500 mg/g, a lower SBP target of <130 mmHg should be proposed for renal protection 3.
- The 2017 American Heart Association/American College of Cardiology (AHA/ACC) guidelines established 130/80 mmHg as the threshold for the diagnosis- and treatment-target BP level 4.
Special Considerations
- In elderly patients, the target BP should be less than 140 mmHg if no orthostatic hypotension occurs, and less than 120 mmHg in high-risk patients 3.
- In patients with non-proteinuric chronic kidney disease, the target BP should be less than 140 mmHg, but for patients with protein-creatinine ratio >500 mg/g, a lower SBP target of <130 mmHg should be proposed for renal protection 3.
- The choice of antihypertensive medication may also affect the target BP, with calcium channel blockers being a viable option for first-line therapy 5, 6.