Initial Blood Pressure Reduction Goal in Hypertension

General Blood Pressure Targets

The American College of Cardiology recommends an initial blood pressure reduction goal of less than 140/90 mmHg for most patients, with more intensive targets of less than 130/80 mmHg for those with diabetes, chronic kidney disease, or high cardiovascular risk 1, 2
For most adults with hypertension, the primary goal is to reduce blood pressure to less than 140/90 mmHg, which is associated with a decrease in cardiovascular disease complications 3
A target of 120-129/70-79 mmHg is recommended if well tolerated, according to the European Society of Cardiology 2
The magnitude of BP reduction with standard doses of first-line antihypertensive medications is approximately 9/5 mmHg with office BP measurements 2
Initial BP reduction should be gradual, especially in older adults, to avoid adverse effects from too rapid lowering, as recommended by the European Heart Journal 4

For patients with diabetes or chronic kidney disease, a more aggressive target of less than 130/80 mmHg is recommended by the American Diabetes Association and the European Heart Journal 3, 5
For patients with proteinuria, maintaining blood pressure even below 125/75 mmHg may be beneficial for reducing progression of renal disease, according to the American Diabetes Association 7
Patients with high cardiovascular risk should aim for a BP target of less than 130/80 mmHg, as recommended by the American College of Cardiology 1

For Stage 1 Hypertension, begin with a single antihypertensive agent and titrate dosage before adding additional agents, as recommended by the American Academy of Family Physicians 3, 1
For Stage 2 Hypertension, initiate treatment with a two-drug combination for most patients, usually including a thiazide-type diuretic plus an ACE inhibitor, ARB, beta-blocker, or CCB, as recommended by the American Academy of Family Physicians and the American College of Cardiology 3, 1

After initiating antihypertensive therapy, follow-up should occur at monthly intervals until control is achieved, as recommended by the American College of Cardiology 1
Assess both adherence and response to treatment at each follow-up visit, according to the American College of Cardiology 1
For patients with diabetes, blood pressure should be measured at every routine visit, as recommended by the European Association for the Study of Diabetes 6
In patients treated with ACE inhibitors, ARBs, or diuretics, monitor renal function and potassium levels within the first 3 months of treatment, as recommended by the European Association for the Study of Diabetes 6

Avoid excessive rapid lowering of blood pressure, which may lead to orthostatic hypotension, especially in older adults, as warned by the European Heart Journal 4, 2
Be cautious with initial combined therapy in patients at risk for orthostatic hypotension, as advised by the American Academy of Family Physicians 3
Most patients with hypertension will require two or more medications to achieve their blood pressure goal, according to the American Academy of Family Physicians and the European Heart Journal 3