From the Guidelines
Blood pressure goals vary by age, with general targets being below 120/80 mmHg for most adults, but the most recent and highest quality study 1 recommends targeting systolic BP to 130 mmHg in patients with diabetes and <130 mmHg if tolerated, but not <120 mmHg, and a range of 130 - 139 mmHg for older people aged >65 years.
Key Considerations
- For adults under 65 without other health conditions, maintaining blood pressure below 130/80 mmHg is recommended 1.
- For older adults aged 65+, a slightly higher target of below 140/90 mmHg is often acceptable, balancing cardiovascular protection with medication side effect risks 1.
- For those with diabetes or kidney disease, stricter goals of below 130/80 mmHg are typically advised regardless of age 1.
- Children and adolescents have age-specific targets that are lower than adult values, with normal readings varying by height, weight, and age.
Lifestyle Modifications
- Regular monitoring is essential, and blood pressure management should include lifestyle modifications like:
- Reduced sodium intake
- Regular exercise
- Maintaining a healthy weight
- Dietary changes, such as the DASH diet
- These lifestyle modifications can be used alongside any prescribed medications to achieve optimal blood pressure control.
Pharmacologic Treatment
- The choice of antihypertensive medication should be based on individual patient characteristics and comorbidities 1.
- Thiazide-type diuretics, calcium-channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers are commonly used first-line agents 1.
- Dual therapy with a renin-angiotensin-aldosterone system blocker and a calcium channel blocker or diuretic may be necessary to achieve optimal blood pressure control 1.
From the Research
Blood Pressure Goals by Age Range
The American College of Cardiology (ACC)/American Heart Association (AHA) recommends the following blood pressure goals:
- For adults aged 60-79 years, the blood pressure should be reduced to less than 140/90 mmHg 2
- For adults aged 80 years and older, the systolic blood pressure should be reduced to 140 to 145 mmHg if tolerated, with a target goal of less than 140/90 mmHg considered in those with diabetes mellitus or chronic kidney disease 2
- The 2013 Eighth Joint National Committee (JNC 8) guidelines recommend reducing the blood pressure to less than 140/90 mmHg in adults aged 60 years and older with diabetes mellitus or chronic kidney disease, but to less than 150/90 mmHg in adults aged 60 years and older without diabetes mellitus or chronic kidney disease 2
Blood Pressure Targets in Specific Populations
- For adults with diabetes and hypertension, treatment with an ACE inhibitor or ARB is recommended to reduce the risk of cardiovascular disease and renal disease 3
- The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines propose a blood pressure target of less than 130/80 mmHg for all adults, including those with diabetes and kidney disease 4
Renal Disease Considerations
- Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are recommended for preventing the progression of diabetic kidney disease 5, 6
- These medications may prevent kidney failure, doubling of serum creatinine, and the progression from microalbuminuria to macroalbuminuria in adults with diabetes and kidney disease 6