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

 

 

 

How effective is blood pressure lowering in reducing the risk of future cardiovascular events?

Effects of lowering blood pressure:

  • in a large-scale analysis of randomised trials (3)
    • a 5 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular events (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital) by about 10%, irrespective of previous diagnoses of cardiovascular disease, and even at normal or high-normal blood pressure values

    • hazard ratios (HR) associated with a reduction of systolic blood pressure by 5 mm Hg for a major cardiovascular event
      • in participants without previous cardiovascular disease was 0.91, 95% CI 0.89-0.94
      • in partipants with previous cardiovascular disease was 0.89, 0.86-0.92

    • findings suggest that a fixed degree of pharmacological blood pressure lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at blood pressure levels currently not considered for treatment

What should be the blood pressure target if increased cardiovascular risk (4)

  • the SPRINT Research Group noted that among patients who were at increased cardiovascular risk
    • targeting a systolic blood pressure of less than 120 mm Hg resulted in lower rates of major adverse cardiovascular events and lower all-cause mortality than targeting a systolic blood pressure of less than 140 mm Hg, both during receipt of the randomly assigned therapy and after the trial
    • rates of some adverse events were higher in the intensive-treatment group

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.
  3. The Blood Pressure Lowering Treatment Trialists' Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 2021; 397: 1625-36.
  4. The SPRINT Research Group. Final Report of a Trial of Intensive versus Standard Blood-Pressure Control.N Engl J Med 2021; 384:1921-1930

Last edited 05/2021 and last reviewed 06/2021

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