Hypertension: Target Blood Pressure Levels Reference # 239

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Hypertension: Target Blood Pressure Levels

Key Highlights from the Recommended Guideline

• Aim for a blood pressure < 140/90 mm Hg (< 130/80 mm Hg in patients with diabetes or renal disease)

• Prioritize control of systolic blood pressure, a much stronger cardiovascular risk factor than diastolic blood pressure

Scope: Health professionals involved in the care of adults who have or are at risk for hypertension

What are the benefits of lowering blood pressure? • Treat hypertension in order to reduce(1) stroke by 35%–40%; (2) myocardial infarction

by 20%–25 %, and (3) heart failure by >50 %. [Level of Evidence: M] What blood pressures should I aim for when treating my patients with hypertension?

• Aim for a target blood pressure < 140/90 mm Hg in most patients to decrease

cardiovascular complications. [Level of Evidence: RA] • Aim for <130/80 mm Hg in patients with diabetes or renal disease. [Level of

Evidence: PR] • Focus on systolic rather than diastolic blood pressure, because:

o Systolic blood pressure is a stronger cardiovascular risk factor than diastolic blood pressure in patients over 50 years old. [Level of Evidence: F]

o Poor control of systolic blood pressure is a key factor in poor overall blood

pressure control. [Level of Evidence: X, F]

Hypertension: Target Blood Pressure Levels

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Reference # 239

Should I be concerned about “pre-hypertension” (120-129/80-89 mm Hg) in patients without diabetes or renal disease? Should I be concerned about “pre-hypertension” (120-129/80-89 mm Hg) in patients without diabetes or renal disease? • Be aware that patients with pre-hypertension are at high risk for developing frank

hypertension. [Level of Evidence: Not stated] • Be aware that patients with pre-hypertension are at high risk for developing frank

hypertension. [Level of Evidence: Not stated] • Aim to decrease the later development of hypertension. [Level of Evidence: Not

stated] • Aim to decrease the later development of hypertension. [Level of Evidence: Not

stated]

• Focus on lifestyle modifications to reduce the risk of later hypertension. [Level of Evidence: Not stated]

• Focus on lifestyle modifications to reduce the risk of later hypertension. [Level of Evidence: Not stated]

• Do not use antihypertensive drug treatment. [Level of Evidence: Not stated] • Do not use antihypertensive drug treatment. [Level of Evidence: Not stated]

Levels of Evidence Levels of Evidence The levels of evidence used to grade the recommendations in this guideline are as follows: The levels of evidence used to grade the recommendations in this guideline are as follows:

Level M Level M Meta-analysis; use of statistical methods to combine the results from clinical trials Meta-analysis; use of statistical methods to combine the results from clinical trials Level RA Randomized controlled trials; also known as experimental studies Level RE Retrospective analyses; also known as case-control studies Level F Prospective study; also known as cohort studies, including historical or prospective

follow-up studies Level X Cross-sectional surveys; also known as prevalence studies Level PR Previous review or position statements Level C Clinical interventions (nonrandomized)

The above recommendations were derived from the following GAC endorsed guideline:

National Heart, Lung, and Blood Institute. (2003, May). The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure: The complete report. Retrieved November 20, 2007 from: http://www.nhlbi.nih.gov/guidelines/hypertension/ Rating (out of 4):

Endorsed Date: September 2005 Planned Review Date: September 2008

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