Blood Pressure Targets in Adults With Hypertension
Publication Date: November 13, 2022
Last Updated: May 1, 2023
Summary of Recommendations
Recommendation 1
The American Academy of Family Physicians (AAFP) strongly recommends clinicians treat adults who have hypertension to a standard blood pressure target (less than 140/90 mm Hg) to reduce the risk of all cause and cardiovascular mortality (strong recommendation; high-quality evidence). Treating to a lower blood pressure target (less than 135/85 mm Hg) did not provide additional benefit at preventing mortality; however, a lower blood pressure target could be considered based on clinical assessment and patient preferences and values.
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Recommendation 2
The AAFP recommends clinicians consider treating adults who have hypertension to a lower blood pressure target (less than 135/85 mm Hg) to reduce risk of myocardial infarction (weak recommendation; moderate-quality evidence). Although treatment to a standard blood pressure target (less than 140/90 mm Hg) reduced the risk of myocardial infarction, there was a small additional benefit observed with a lower blood pressure target. There was no observed additional benefit in preventing stroke with the lower blood pressure target.
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Table
Table 4. Comparison of Recommended Blood Pressure Targets in Recent Guidelines
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| Guideline | 18 to 59 years of age (mm Hg) | 60 to 69 years of age (mm Hg) | 70 to 79 years of age (mm Hg) | Older than 80 years (mm Hg) |
| 2022 American Academy of Family Physicians* | < 140/90 | < 140/90 | < 140/90 | < 140/90 |
| 2022 National Institute for Health and Care Excellence | < 140/90 | < 140/90 | < 140/90 | < 150/90 |
| 2021 European Society of Hypertension Council | < 130/80† | < 130/80† | < 140/80 | < 140/80 |
| 2020 International Society of Hypertension‡ | < 130/80 | < 140/90§ | < 140/90 | < 140/90 |
| 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense|| | < 130/90¶ | < 150/90 | < 150/90 | < 150/90 |
| 2017 American College of Cardiology/American Heart Association* | < 130/80 | < 130/80 | < 130/80 | < 130/80 |
| 2017 American College of Physicians and American Academy of Family Physicians | N/A | < 150/90 | < 150/90 | < 150/90 |
| 2014 Eighth Joint National Committee | < 140/90 | < 150/90 | < 150/90 | < 150/90 |
*—Lower targets are reasonable based on clinical judgment and patient preferences or values
†—A target of less than 140/90 mm Hg is recommended for patients with chronic kidney disease.
‡—Recommendation is to treat all patients to less than 140/90 mm Hg but states it is optimal to treat persons younger than 65 years and people with coronary artery disease, chronic kidney disease, heart failure, previous stroke, chronic obstructive pulmonary disease, or diabetes mellitus to less than 130/80 mm Hg (less than 140/80 mm Hg in older patients).
§—Recommendation is to transition from target of 130/80 mm Hg to 140/90 mm Hg at 65 years of age.
||—A target of less than 140/90 mm Hg is recommended in patients with diabetes.
¶—Recommendation is to treat all patients 18 to 59 years of age (including those with diabetes) to a systolic blood pressure target of less than 130 mm Hg. For patients 30 years and older, a diastolic blood pressure target of less than 90 mm Hg is recommended.
†—A target of less than 140/90 mm Hg is recommended for patients with chronic kidney disease.
‡—Recommendation is to treat all patients to less than 140/90 mm Hg but states it is optimal to treat persons younger than 65 years and people with coronary artery disease, chronic kidney disease, heart failure, previous stroke, chronic obstructive pulmonary disease, or diabetes mellitus to less than 130/80 mm Hg (less than 140/80 mm Hg in older patients).
§—Recommendation is to transition from target of 130/80 mm Hg to 140/90 mm Hg at 65 years of age.
||—A target of less than 140/90 mm Hg is recommended in patients with diabetes.
¶—Recommendation is to treat all patients 18 to 59 years of age (including those with diabetes) to a systolic blood pressure target of less than 130 mm Hg. For patients 30 years and older, a diastolic blood pressure target of less than 90 mm Hg is recommended.
Video
Recommendation Grading
Overview
Title
Blood Pressure Targets in Adults With Hypertension
Authoring Organization
American Academy of Family Physicians
Publication Month/Year
November 13, 2022
Last Updated Month/Year
September 10, 2024
Supplemental Implementation Tools
Document Type
Guideline
Country of Publication
US
Document Objectives
The purpose of this guideline is to provide recommendations relevant to primary care for blood pressure treatment targets. This guideline will not discuss specific pharmacologic or other hypertension treatments. The target audience includes family physicians and other primary care clinicians. The target patient population is adults with hypertension, with or without CVD.
Target Patient Population
Adults with hypertension
Target Provider Population
Family medicine specialists, internists and other allied providers caring for adults with high blood pressure
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Management
Diseases/Conditions (MeSH)
D006973 - Hypertension
Keywords
blood pressure, hypertension, high blood pressure, blood pressure targets