Blood Pressure Management for Adults

Current Guideline Recommendations

The European Society of Cardiology (ESC) recommends a systolic blood pressure (SBP) target of 120-129 mmHg for most adults, including those in their 60s, provided the treatment is well tolerated 2
A diastolic blood pressure (DBP) target of <80 mmHg is recommended for all hypertensive patients, with an optimal range of 70-79 mmHg 2
The American College of Cardiology/American Heart Association recommends BP <130/80 mmHg for adults with hypertension, including those aged 65 years and older 1, 3
For adults aged 65 years and older, the ESC recommends a systolic BP target range of 130-139 mmHg if the lower target cannot be achieved without adverse effects 2
More lenient targets (e.g., <140/90 mmHg) should only be considered in specific circumstances such as symptomatic orthostatic hypotension, moderate-to-severe frailty, or limited life expectancy (<3 years) 2

Recent clinical trials including SPRINT, STEP, and ESPRIT have demonstrated cardiovascular benefits with more intensive blood pressure control 4
Meta-analyses have shown that age is not an effect modifier for treatment efficacy at least up to 85 years, supporting similar targets across age groups 4
The 2022 harmonization document between American and European guidelines confirms the benefit of targeting SBP <130 mmHg in adults with hypertension 1

For patients with chronic kidney disease (CKD), a BP goal of less than 130/80 mmHg is strongly recommended 5
In patients with CKD and albuminuria, treatment with an ACE inhibitor is reasonable to slow kidney disease progression 5
For patients with diabetes, a BP target of <130/80 mmHg is recommended, with some guidelines suggesting a lower diastolic target (<85 mmHg) 6, 7

Initial therapy should include lifestyle modifications for all patients 8
For most patients requiring pharmacological therapy, a combination of drugs is often needed to achieve the target BP 8
First-line medications include ACE inhibitors, ARBs, calcium channel blockers, and thiazide or thiazide-like diuretics 2
For patients not at target with a three-drug combination, spironolactone should be considered as the fourth agent 2

After initiating treatment, follow-up should occur within the first 2 months 1
Once the target BP is achieved, monitoring should occur every 3-6 months 5
The goal should be to achieve the target BP within 3 months of initiating therapy 1