There is some controversy surrounding blood pressure goals for individuals with hypertension, particularly in the elderly. A new article published in JAMA highlights these inconsistencies and suggests blood pressure goals based on the evidence available at the present time.
A healthy individual generally has a systolic blood pressure (SBP) of 120 mmHg and a diastolic blood pressure (DBP) of 80 mmHg, where systolic represents the maximum pressure exerted on the arteries by the heart and diastolic represents the minimum. When these blood pressure values are elevated, an individual is said to have hypertension or high blood pressure. While hypertension does not usually cause any noticeable symptoms, it is a major risk factor for a number of conditions including coronary artery disease, stroke, heart failure, and kidney disease.
For individuals with hypertension, Hypertension Canada has set a goal blood pressure that patients can seek to achieve through medical treatment. The current treatment goals are an SBD of less than 140 mmHg and a DBP of less than 90 mmHg. However, blood pressure goals are largely speculative and are based on findings from a number of clinical trials, which assessed subjects of various ages, severity of disease and a number of comorbidities. A new opinion piece published in JAMA summarized the controversy that exists on blood pressure goals.
The article states that three major groups have made new recommendations for blood pressure goals. The Joint National Committee (JNC) 8 raised the SBP goal for individuals over the age of 60 to less than 150 mmHg (as opposed to less than 140 mmHg for other adults). The European Society of Hypertension has advocated a goal of less than 140-150 mmHg for those over the age of 80, whilst the American Society of Hypertension has recommended a target of less than 150/90 mmHg for those above 80 years of age. These inconsistencies are challenging for physicians who are treating individuals with hypertension.
Importantly, treatment decisions should be guided by a patient’s blood pressure values as well as their individual health concerns, including age and comorbidities. Based on all available evidence, the article suggests that for most adults under 50, the goal blood pressure should be less than 120/80 mmHg. In those with cardiovascular disease, however, an SBP goal of less than 130 mmHg is sufficient in conjunction with lifestyle modifications, including exercise and proper nutrition.
For individuals between 50-74 years of age, an SBP goal of less than 130 mmHg is suggested. However, it is recommended to first achieve a target of 140 mmHg, and if that target is well-tolerated, to then proceed to 130 mmHg. These criteria include individuals with cardiovascular disease, chronic kidney disease, and type 2 diabetes.
Lastly, for those over the age of 75, the exact SBP goal is still unclear. Currently, a goal of less than 140 mmHg is recommended, but should be achieved through careful dosing and consistent monitoring for hypotension, changes in renal function, and effects on cognition.
Of course, the overall goal of blood pressure treatment is to prevent hypertension. Clinicians should advocate a healthy lifestyle to individuals who exhibit prehypertension blood pressure values. Further research is warranted to determine better blood pressure goals, particularly in the elderly.
Written By: Neeti Vashi, BSc