What are the guidelines for blood pressure readings in a patient on antihypertensive (blood pressure) medication?

From the Guidelines

For individuals on blood pressure medication, the general target blood pressure reading is below 130/80 mmHg. This goal may be adjusted based on individual factors such as age, other health conditions, and specific medication regimens. When taking blood pressure medications like ACE inhibitors (e.g., lisinopril), ARBs (e.g., losartan), calcium channel blockers (e.g., amlodipine), or diuretics (e.g., hydrochlorothiazide), it's essential to monitor your blood pressure regularly, ideally at the same time each day. Use a properly calibrated home blood pressure monitor, sit quietly for 5 minutes before measuring, keep your back supported, feet flat on the floor, and arm at heart level. Take 2-3 readings one minute apart and record the average. If your readings consistently exceed 130/80 mmHg while taking medication as prescribed, or if they drop below 90/60 mmHg causing dizziness or fatigue, contact your healthcare provider as your medication may need adjustment. These targets help prevent cardiovascular complications like heart attacks and strokes by maintaining optimal pressure in your blood vessels, reducing strain on your heart and protecting your organs from damage caused by chronically elevated pressure, as recommended by the 2017 American College of Cardiology/American Heart Association hypertension guideline 1.

Some key points to consider when monitoring blood pressure include:

• Using out-of-office BP measurements to confirm the diagnosis of hypertension and titrate medication 1
• Screening for masked uncontrolled hypertension if the office BP is at goal but CVD risk is increased or target organ damage is present 1
• Adjusting the target BP based on individual factors, such as age, other health conditions, and specific medication regimens 1
• Considering the use of ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM) to detect white coat hypertension and masked hypertension 1

It's also important to note that the American College of Cardiology/American Heart Association hypertension guideline recommends a blood pressure target of less than 130/80 mmHg for most individuals, with some exceptions for certain high-risk populations 1. Overall, working closely with your healthcare provider to manage your blood pressure and adjust your medication as needed is crucial to achieving optimal blood pressure control and reducing the risk of cardiovascular complications.

From the FDA Drug Label

For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)

• The guideline for blood pressure readings for someone on blood pressure medication is to follow the published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).
• The JNC guidelines should be consulted for specific advice on blood pressure goals and management 2.

From the Research

Blood Pressure Readings for Individuals on Medication

The guidelines for blood pressure readings for individuals on blood pressure medication vary based on several factors, including the presence of underlying conditions such as diabetes, renal disease, or heart failure.

• For hypertensive persons with diabetes, renal disease, or heart failure, the goal blood pressure level should be lower than 130/85 mm Hg 3.
• For all other hypertensive individuals, the goal blood pressure level should be minimally lower than 140/90 mm Hg 3.
• In elderly patients (aged 65-80 years), it is recommended to maintain systolic blood pressure below 130 mmHg 4.
• For patients with chronic kidney disease (CKD), a systolic blood pressure target below 120 mmHg can be recommended if well-tolerated 4.

Considerations for Special Populations

Certain populations require special consideration when it comes to blood pressure management:

• In black patients, at least one agent should be a thiazide diuretic or a calcium channel blocker 5.
• Patients with heart failure with reduced ejection fraction should be treated initially with a beta blocker and an ACEI or ARB 5.
• Patients with diabetes mellitus should be treated similarly to those without diabetes unless proteinuria is present, in which case combination therapy should include an ACEI or ARB 5.
• Elderly patients with diabetes and hypertension should be treated with an ACE inhibitor or ARB, as recommended for younger diabetics 6.

Medication Considerations

The selection of antihypertensive medications requires consideration of the patient's cardiovascular condition and potential contraindications:

• Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the primary choices for patients with CKD 4.
• Combination therapy may be necessary to achieve the desired blood pressure target 5, 4.
• The 2017 ACC/AHA blood pressure guideline provides updated recommendations for antihypertensive medication initiation and intensification, directing treatment to adults with high cardiovascular risk 7.