From the Guidelines
The goal blood pressure value for most adults, particularly those with diabetes, is less than 130/80 mmHg, as recommended by the most recent guidelines 1.
Key Considerations
- For individuals with hypertension, treatment typically aims to bring systolic blood pressure below 130 mmHg and diastolic blood pressure below 80 mmHg.
- However, these targets may vary based on individual factors, such as age, the presence of diabetes or chronic kidney disease, and cardiovascular risk.
- The American Diabetes Association and other organizations suggest that for individuals with diabetes and hypertension at higher cardiovascular risk, a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained 1.
- Some studies, like the SPRINT trial, have shown benefits of more intensive blood pressure control, but these must be balanced against potential risks, especially in older adults or those with certain comorbidities 1.
Evidence-Based Recommendations
- The 2025 standards of care in diabetes recommend treating people with diabetes who have hypertension to blood pressure goals of <130/80 mmHg, based on evidence from trials like ADVANCE and SPRINT 1.
- Lifestyle modifications, including reducing sodium intake, maintaining a healthy weight, regular physical activity, limiting alcohol consumption, and following a DASH diet, are foundational for blood pressure management.
- Blood pressure should be measured correctly after 5 minutes of rest, with the arm supported at heart level, using a properly calibrated device.
Individualized Approach
- Blood pressure targets should be individualized through a shared decision-making process that addresses cardiovascular risk, potential adverse effects of antihypertensive medications, and patient preferences 1.
- For older adults (over 65) or those at lower risk for cardiovascular disease, slightly less stringent targets may be appropriate to avoid side effects from aggressive treatment.
- Patients with coronary artery disease or chronic kidney disease may require more stringent blood pressure control to minimize cardiovascular risk.
From the FDA Drug Label
If goal blood pressure (<140/90 mmHg) was not reached, hydrochlorothiazide (12.5 mg) was added first and, if needed, the dose of losartan or atenolol was then increased to 100 mg once daily. The goal blood pressure values are less than 140/90 mmHg 2.
From the Research
Goal Blood Pressure Values
- The goal blood pressure values are a topic of debate, with some studies suggesting that a blood pressure of less than 130/80 mmHg is optimal 3, 4.
- However, other studies suggest that this goal may not be necessary for all patients, and that a blood pressure of less than 140/90 mmHg may be sufficient 3, 5.
- The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend a blood pressure goal of less than 130/80 mmHg for most patients 4.
- However, some studies suggest that this goal may be too aggressive, and that a blood pressure of less than 140/90 mmHg may be more appropriate for some patients 3, 5.
Blood Pressure Targets for Specific Patient Populations
- For patients with diabetes or kidney disease, a blood pressure goal of less than 130/80 mmHg may be recommended 3.
- However, for patients with advanced proteinuric chronic kidney disease (CKD), a blood pressure goal of less than 130/80 mmHg may be necessary to slow disease progression 3.
- For patients with a history of stroke or multiple risk factors for stroke, a blood pressure goal of less than 130/80 mmHg may be recommended 3.
Achieving Goal Blood Pressure Values
- Combination therapy with beta-blockers and angiotensin-converting enzyme (ACE) inhibitors may be effective in achieving goal blood pressure values 6.
- Diuretics and calcium-channel blockers may also be effective in lowering blood pressure and achieving goal blood pressure values 5.
- The choice of antihypertensive medication should be individualized based on the patient's specific needs and medical history 5, 7.