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target blood pressure (BP ) levels

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BP targets

  • NICE suggest (1):


  • NICE suggest target blood pressure levels in people with CKD:
    • in people with CKD aim to keep the systolic blood pressure below 140 mmHg (target range 120-139 mmHg) and the diastolic blood pressure below 90 mmHg
    • in people with CKD and diabetes, and also in people with an ACR of 70 mg/mmol or more, aim to keep the systolic blood pressure below 130 mmHg (target range 120-129 mmHg) and the diastolic blood pressure below 80 mmHg

  • patients who are at the highest baseline risk of CVD have the most to gain from lowering of BP. Although it may not be possible to achieve target in all patients, any lowering of BP is beneficial. Aim to achieve the largest reduction possible towards the target, taking into account tolerability and concordance for each individual patients

Continuing treatment

  • provide an annual review of care to monitor blood pressure, provide patients with support and discuss their lifestyle, symptoms and medication
  • patients may become motivated to make lifestyle changes and want to stop using antihypertensive drugs. If at low cardiovascular risk and with well controlled blood pressure, these patients should be offered a trial reduction or withdrawal of therapy with appropriate lifestyle guidance and ongoing review

Please consult the complete guideline for more detailed advice

Notes:

  • The American college of cardiology has recommended BP thresholds for initiating antihypertensive treatment in patients with following medical conditions:

clinical condition(s)

BP threshold (to initiate treatment) mmHg

BP goal (mmHg)

general

clinical CVD or 10-year atherosclerotic cardiovascular disease (ASCVD) risk >=10%

>=130/80

<130/80

no clinical CVD and 10 year ASCVD risk <10%

>=140/90

<130/80

older persons ( >=65 years of age; non-institutionalized, ambulatory, community-living adults)

>=130 (SBP)

<130 (SBP)

specific comorbidities

 

 

diabetes

>=130/80

<130/80

chronic kidney disease

>=130/80

<130/80

chronic kidney disease post-renal transplant

>=130/80

<130/80

heart failure

>=130/80

<130/80

stable ischemic heart disease

>=130/80

<130/80

secondary stroke prevention

>=140/90

<130/80

peripheral arterial disease

>=130/80

<130/80

 

 

 

Reference:

  1. NICE (August 2019). Clinical management of primary hypertension in adults
  2. Whelton PK et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138(17):e426-e483.

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