Editing Hypertension (section)

=== Target blood pressure ===
{{See also|Comparison of international blood pressure guidelines}}

Various expert groups have produced guidelines regarding how low the blood pressure target should be when a person is treated for hypertension. These groups recommend a target below the range of 140–160 / 90–100 mmHg for the general population.<ref name="ESH2023" /><ref name="JNC8"/><ref name="Daskalopoulou_2015">{{cite journal | vauthors = Daskalopoulou SS, Rabi DM, Zarnke KB, Dasgupta K, Nerenberg K, Cloutier L, etal | title = The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension | journal = The Canadian Journal of Cardiology | volume = 31 | issue = 5 | pages = 549–568 | date = May 2015 | pmid = 25936483 | doi = 10.1016/j.cjca.2015.02.016 | url = https://escholarship.mcgill.ca/concern/articles/rb68xh61n | doi-access = free }}</ref><ref name="NICE">{{cite web | title = Hypertension: Recommendations, Guidance and guidelines | work = NICE | url = http://www.nice.org.uk | archive-url=https://web.archive.org/web/20061003082330/http://www.nice.org.uk/ | archive-date = 3 October 2006 | access-date = 4 August 2015 }}</ref> [[Cochrane (organisation)|Cochrane]] reviews recommend similar targets for subgroups such as people with diabetes<ref name="Arg2013">{{cite journal | vauthors = Arguedas JA, Leiva V, Wright JM | title = Blood pressure targets for hypertension in people with diabetes mellitus | journal = The Cochrane Database of Systematic Reviews | issue = 10 | pages = CD008277 | date = October 2013 | pmid = 24170669 | doi = 10.1002/14651858.cd008277.pub2 | pmc = 11365096 }}</ref> and people with prior cardiovascular disease.<ref>{{cite journal | vauthors = Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L | title = Blood pressure targets for the treatment of people with hypertension and cardiovascular disease | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 11 | pages = CD010315 | date = November 2022 | pmid = 36398903 | pmc = 9673465 | doi = 10.1002/14651858.CD010315.pub5 }}</ref> Additionally, Cochrane reviews have found that for older individuals with moderate to high cardiovascular risk, the benefits of trying to achieve a lower-than-standard blood pressure target (at or below 140/90 mmHg) are outweighed by the risk associated with the intervention.<ref name="Arguedas_2020">{{cite journal | vauthors = Arguedas JA, Leiva V, Wright JM | title = Blood pressure targets in adults with hypertension | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 12 | pages = CD004349 | date = December 2020 | pmid = 33332584 | pmc = 8094587 | doi = 10.1002/14651858.CD004349.pub3 }}</ref> These findings may not be applicable to other populations.<ref name="Arguedas_2020" />

Many expert groups recommend a slightly higher target of 150/90 mmHg for those somewhere between 60 and 80 years of age.<ref name="Daskalopoulou_2015"/><ref name="NICE"/><ref name=ACP2017>{{cite journal | vauthors = Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA | title = Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians | journal = Annals of Internal Medicine | volume = 166 | issue = 6 | pages = 430–437 | date = March 2017 | pmid = 28135725 | doi = 10.7326/M16-1785 | doi-access = free }}</ref> The JNC 8 and [[American College of Physicians]] recommend the target of 150/90 mmHg for those over 60 years of age,<ref name="JNC8"/><ref name=ACP2017/> but some experts within these groups disagree with this recommendation.<ref>{{cite journal | vauthors = Wright JT, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR | title = Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view | journal = Annals of Internal Medicine | volume = 160 | issue = 7 | pages = 499–503 | date = April 2014 | pmid = 24424788 | doi = 10.7326/m13-2981 | doi-access = free }}</ref> Some expert groups have also recommended slightly lower targets in those with [[diabetes]]<ref name=ADA2018>{{Cite journal |last1=Passarella |first1=Pasquale |last2=Kiseleva |first2=Tatiana A. |last3=Valeeva |first3=Farida V. |last4=Gosmanov |first4=Aidar R. |date=2018-08-01 |title=Hypertension Management in Diabetes: 2018 Update |journal=Diabetes Spectrum |language=en |volume=31 |issue=3 |pages=218–224 |doi=10.2337/ds17-0085 |issn=1040-9165 |pmc=6092891 |pmid=30140137}}</ref> or [[chronic kidney disease]],<ref name=KDIGO2022>{{Cite journal |last1=Cheung |first1=Alfred K. |last2=Chang |first2=Tara I. |last3=Cushman |first3=William C. |last4=Furth |first4=Susan L. |last5=Hou |first5=Fan Fan |last6=Ix |first6=Joachim H. |last7=Knoll |first7=Gregory A. |last8=Muntner |first8=Paul |last9=Pecoits-Filho |first9=Roberto |last10=Sarnak |first10=Mark J. |last11=Tobe |first11=Sheldon W. |last12=Tomson |first12=Charles R.V. |last13=Mann |first13=Johannes F.E. |date=March 2021 |title=KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease |journal=Kidney International |language=en |volume=99 |issue=3 |pages=S1–S87 |doi=10.1016/j.kint.2020.11.003|doi-access=free |pmid=33637192 }}</ref> but others recommend the same target as the general population.<ref name="JNC8"/><ref name=Arg2013/> The issue of what is the best target and whether targets should differ for high-risk individuals is unresolved,<ref>{{cite journal | vauthors = Brunström M, Carlberg B | title = Lower blood pressure targets: to whom do they apply? | journal = Lancet | volume = 387 | issue = 10017 | pages = 405–406 | date = January 2016 | pmid = 26559745 | doi = 10.1016/S0140-6736(15)00816-8 | s2cid = 44282689 | url = https://zenodo.org/record/896834 }}</ref> although some experts propose more intensive blood pressure lowering than advocated in some guidelines.<ref>{{cite journal | vauthors = Xie X, Atkins E, Lv J, Rodgers A | title = Intensive blood pressure lowering – Authors' reply | journal = Lancet | volume = 387 | issue = 10035 | pages = 2291 | date = June 2016 | pmid = 27302266 | doi = 10.1016/S0140-6736(16)30366-X | doi-access = free }}</ref>

For people who have never experienced cardiovascular disease who are at a 10-year risk of cardiovascular disease of less than 10%, the 2017 American Heart Association guidelines recommend medications if the systolic blood pressure is >140 mmHg or if the diastolic BP is >90 mmHg.<ref name="AHA2017"/> For people who have experienced cardiovascular disease or those who are at a 10-year risk of cardiovascular disease of greater than 10%, it recommends medications if the systolic blood pressure is >130 mmHg or if the diastolic BP is >80 mmHg.<ref name="AHA2017"/>