Blood Pressure Management Goals and Targets

Primary Treatment Targets by Patient Category

The American College of Cardiology (ACC) and American Heart Association (AHA) recommend a target blood pressure of <130/80 mmHg for most adults under 65 years 5, 6
For adults 65 years and older, the target systolic blood pressure is <130 mmHg (no specific diastolic target recommended) 5, 6
High-risk patients should achieve a blood pressure of <130/80 mmHg or systolic <130 mmHg 1, 2, 3, 4, 7
The ACC/AHA guidelines define high-risk status as having known cardiovascular disease, diabetes mellitus, chronic kidney disease, or a high calculated cardiovascular risk (≥10% 10-year ASCVD risk) 1, 2, 3, 4, 5, 6

For high-risk patients, initiate pharmacological treatment at a blood pressure of ≥130/80 mmHg 5, 6, 1, 2, 4
For standard-risk patients, initiate pharmacological treatment at a blood pressure of ≥140/90 mmHg 5, 6, 1, 2, 4

For Stage 2 hypertension (≥140/90 mmHg), initiate treatment with two-drug combination therapy when blood pressure is >20/10 mmHg above goal 5, 6, 7
Preferably use single-pill combination to improve adherence 1, 2, 3, 4

Avoid lowering diastolic blood pressure below 60 mmHg in high-risk patients with treated systolic blood pressure <130 mmHg, as this may increase cardiovascular events 1, 2, 3, 4
Optimal diastolic blood pressure appears to be 70-80 mmHg in this population 1, 2, 3, 4

Monthly follow-up after initiating or changing medications until target blood pressure is achieved 1, 2, 3, 4, 7
Every 3-5 months for patients at goal 1, 2, 3, 4
Assess both adherence and response at each visit 7
For patients on ACE inhibitors, ARBs, or diuretics, monitor renal function and potassium within the first 3 months 7