The American College of Cardiology and the American Heart Association (AHA/ACC) recommend a blood pressure (BP) goal for individuals with hypertension less than 130/80 mmHg for most adults, including those with clinical cardiovascular disease, diabetes, chronic kidney disease, or a 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 10% or higher.1,2 For older adults (≥65 years), the goal of a systolic blood pressure is less than 130 mm Hg, without a specific diastolic target.1
The American Academy of Family Physicians (AAFP) recommends a target BP of less than 140/90 mmHg.3 They also note that a target of less than 135/85 mmHg may be considered to further reduce myocardial infarction (MI) risk.
In a study among 9361 participants aged ≥50 years with elevated cardiovascular risk and baseline systolic blood pressure of 130–180 mmHg, the systolic blood pressure intervention trial (SPRINT) randomized individuals to intensive (<120 mmHg; n=4678) versus standard (<140 mmHg; n=4683) systolic targets over a median follow-up of 3.26 years.4,5 The primary composite outcome (myocardial infarction, acute coronary syndrome not resulting in MI, stroke, heart failure, or cardiovascular death) occurred in 5.2% of the intensive arm versus 6.8% of the standard arm, yielding an absolute risk reduction (ARR) of 1.6% (p<0.001) and a number needed to treat (NNT) of ≈61 to prevent one event.
A systematic review was conducted to compare whether lower BP targets (i.e., <135/85 mmHg) offer additional benefits over standard targets (i.e., <140/90 mmHg).6 The study found no significant difference between the two BP groups for total mortality (Absolute Risk Reduction [ARR] 0.5%, Relative Risk [RR] 0.95, 95% Confidence Interval [CI] [0.86-1.05], p=0.32), cardiovascular mortality (ARR 0.2%, RR 0.90, 95% CI [0.76-1.06], p=0.21), non-cardiovascular mortality (ARR 0.08%, RR 1.02, 95% CI [0.88-1.18], p=0.82), end stage renal disease (ARR 0.1%, RR 1.06, 95% CI [0.83-1.37], p=0.64) and total serious adverse events (ARR 1.1%, RR 1.04, 95% CI [0.99-1.08], p=0.10). While the evidence was of low certainty, the study found that the lower target group had a reduced incidence of MI (ARR 0.73%, RR 0.84, 95% CI [0.73-0.96], p=0.01), congestive heart failure (ARR 0.64%, RR 0.75, 95% CI [0.60-0.92], p=0.007), and stroke (ARR 0.5%, RR 0.88, 95% CI [0.77-1.01], p=0.07).
References
- Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. Sep 10 2019;74(10):e177-e232. doi:10.1016/j.jacc.2019.03.010
- Whelton PK, Carey RM, Aronow WS, 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: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. Hypertension. 2018-06-01 2018;71(6):e13-e115. doi:10.1161/hyp.0000000000000065
- AAFP Issues New Clinical Practice Guideline on Hypertension. Ann Fam Med. Mar-Apr 2023;21(2):190-191. doi:10.1370/afm.2972
- Final Report of a Trial of Intensive versus Standard Blood-Pressure Control. New England Journal of Medicine. 2021;384(20):1921-1930. doi:doi:10.1056/NEJMoa1901281
- Wright JT, Jr., Williamson JD, Whelton PK, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. Nov 26 2015;373(22):2103-16. doi:10.1056/NEJMoa1511939
- Arguedas JA, Leiva V, Wright JM. Blood pressure targets in adults with hypertension. Cochrane Database Syst Rev. Dec 17 2020;12(12):Cd004349. doi:10.1002/14651858.CD004349.pub3
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