Guidelines for blood pressure goals in hypertension management

This study used an evidence-based approach to recommend treatment guidelines, goals and medications in the management of hypertension in adults.

Hypertension (high blood pressure) is one of the most important preventable contributors to disease and death. It can lead to myocardial infarction (heart attack), stroke and kidney failure. Antihypertensive drug treatment is the use of drugs to reduce high blood pressure, and has been shown to have beneficial effects on health outcomes in hypertensive patients.

 Blood pressure is measured in mmHg and is a combination of diastolic and systolic blood pressures. Diastolic blood pressure is the pressure measured between heartbeats i.e. when the heart muscle is relaxed. Systolic blood pressure is the pressure measured when the heart is beating i.e. when the heart muscle is contracting. The American Heart Association defines normal diastolic pressure as 80 mmHg or less, and normal systolic pressure as 120 mmHg or less.

Clinical guidelines for the management of hypertension are on the cusp of moving from research evidence to actions that the clinician can take to improve patient outcomes. This report defined a range of guidelines for the management of hypertension.

A panel with expertise in various areas such as hypertension, cardiology, nursing, pharmacology, clinical trials and evidence-based medicine was put together to review the literature to develop a set of recommendations for hypertension treatment goals.  The study evaluated adults of 18 years and over with hypertension. A number of patient subgroups were included, for example hypertensive patients with diabetes, coronary artery disease, previous history of stroke and chronic kidney failure. The study evaluated randomized clinical trials, as these are less subject to bias than other study designs and represent the gold standard for determining the effectiveness of a drug or treatment strategy.

In the general population aged 60 years or more, the goal for systolic blood pressure should be <150 mmHg. The goal for diastolic blood pressure should be <90 mmHg. This was shown to reduce the incidence of stroke, heart failure and coronary heart disease.

In the general population aged less than 60 years, the goal for systolic blood pressure should be <140 mmHg. The goal for diastolic blood pressure should be <90 mmHg.

In the population aged 18 years or more with chronic kidney disease, the goal for systolic blood pressure should be <140 mmHg. The goal for diastolic blood pressure should be <90 mmHg. For these patients antihypertensive treatment should include an angiotensin-converting enzyme inhibitor (e.g. Capoten) or an angiotensin receptor blocker (e.g. Avapro) to improve kidney outcomes.

In the general nonblack population including those with diabetes, initial antihypertensive drug treatment should include a thiazide-type diuretic (e.g. Esidrix), calcium-channel blocker (e.g. Norvasc), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Initial treatment with a thiazide-type diuretic was more effective than an angiotensin-converting enxyme inhinitor or a calcium-channel blocker in improving heart failure outcomes.

In the general black population including those with diabetes, initial antihypertensive drug treatment should include a thiazide-type diuretic or calcium channel blocker.

If the blood pressure goal is not reached within one month the dose of the initial drug should be increased, or a second drug should be added. 

These guidelines are not a substitute for clinical judgment and decisions in hypertension management should incorporate the characteristics and circumstances of each individual patient.

This is not a comprehensive guideline and is limited in scope.