From the Guidelines
The optimal blood pressure targets for hospitalized patients should be less than 130/80 mmHg, if tolerated, with a first objective of treatment to lower BP to less than 140/90 mmHg in all patients.
Key Considerations
- The European Society of Cardiology recommends targeting treated systolic BP values to 120–129 mmHg in most adults, provided the treatment is well tolerated 1.
- The American College of Cardiology and American Heart Association recommend a general treatment target of less than 130/80 mmHg, if tolerated, with a focus on controlling systolic BP even when diastolic BP is below 70 to 79 mmHg 1.
- Recent evidence suggests that intensive BP control, targeting less than 130/80 mmHg, can reduce the risk of major cardiovascular events, myocardial infarction, and stroke, without increasing the risk of treatment adverse effects 1.
- It is essential to tailor treatment to achieve the best BP possible within the target range, while monitoring for adverse effects, especially in older and frailer patients 1.
- Home and ambulatory BP monitoring are useful tools in addition to proper in-office BP readings to obtain accurate BP readings and recognize white-coat and masked hypertension 1.
From the Research
Optimal Blood Pressure Targets
The optimal blood pressure targets for hospitalized patients are not clearly defined, with various studies suggesting different targets based on individual patient characteristics and comorbidities.
- The American guidelines recommend a target of ≤130/80 mm Hg for essentially all adults 2.
- European guidelines suggest a less aggressive target of <140/90 mm Hg for all hypertensive patients, including those with coronary artery disease 3.
- A systematic review and meta-analysis found that intensive blood pressure-lowering treatment with a target of <130/80 mm Hg was associated with a significant reduction in major cardiovascular events 4.
- Another study found that lowering blood pressure to <120/70 mm Hg may not provide additional benefits and may increase the risk of unwanted effects, such as hypotension and renal dysfunction 5.
Considerations for Individualized Targets
When determining the optimal blood pressure target for an individual patient, several factors should be considered, including:
- Age and frailty 2, 5
- Polypharmacy 2
- Baseline blood pressure 2, 3
- Diastolic blood pressure J-curve 2, 3
- Comorbidities, such as coronary artery disease or chronic kidney disease 3, 6
Evidence from Clinical Trials
Clinical trials have compared the effects of lower versus standard blood pressure targets on cardiovascular outcomes, with mixed results.
- A Cochrane review found that lowering blood pressure to <135/85 mm Hg did not provide a significant reduction in total mortality or cardiovascular mortality compared to standard targets 6.
- The SPRINT trial found that intensive blood pressure-lowering treatment with a target systolic blood pressure of <120 mm Hg reduced the risk of major cardiovascular events and mortality 4.