May is High Blood Pressure Education Month. High blood pressure, also known as hypertension, is a significant controllable risk factor for stroke and heart disease. In this article, we’re going to review the 2022 Blood Pressure Targets in Adults with Hypertension guideline from the American Academy of Family Physicians (AAFP) published on November 14, 2022. This guideline provides recommendations relevant to primary care for blood pressure treatment targets.

This update is based on a systematic review of randomized controlled trials (RCTs) from database inception to May 2019. It is intended for adult patients with hypertension, with or without cardiovascular disease (CVD). 

The two recommendations outlined in this guideline were formulated using a modified version of the GRADE system. Each recommendation provided by the AAFP has undergone thorough evaluation and has been assigned a strength of recommendation grading, categorized as either strong or weak. Additionally, each recommendation has been assigned a certainty of evidence grading, which falls into one of three categories: high, moderate, or low.

Recommendation 1

The AAFP strongly recommends with a high certainty of evidence that clinicians treat adults who have hypertension to a standard blood pressure target (less than 140/90 mm Hg) to reduce the risk of all cause and cardiovascular mortality. This was given a strong recommendation with high-quality evidence.

Additional commentary on treating a lower blood pressure target (less than 135/85 mm Hg) did not provide additional benefit at preventing mortality; however, a lower blood pressure target could be considered based on clinical assessment and patient preferences and values.

Recommendation 2

The AAFP recommends clinicians consider treating adults who have hypertension to a lower blood pressure target (less than 135/85 mm Hg) to reduce risk of myocardial infarction. This was given a weak recommendation with moderate-quality evidence. 

Although treatment to a standard blood pressure target (less than 140/90 mm Hg) reduced the risk of myocardial infarction, there was a small additional benefit observed with a lower blood pressure target. There was no observed additional benefit in preventing stroke with the lower blood pressure target.

Comparison of Recommended Blood Pressure Targets in Recent Guidelines

Guideline18 to 59 years of age (mm Hg)60 to 69 years of age (mm Hg)70 to 79 years of age (mm Hg)Older than 80 years (mm Hg)
2022 American Academy of Family Physicians*< 140/90< 140/90< 140/90< 140/90
2022 National Institute for Health and Care Excellence< 140/90< 140/90< 140/90< 150/90
2021 European Society of Hypertension Council< 130/80†< 130/80†< 140/80< 140/80
2020 International Society of Hypertension‡< 130/80< 140/90§< 140/90< 140/90
2020 U.S. Department of Veterans Affairs/U.S. Department of Defense||< 130/90¶< 150/90< 150/90< 150/90
2017 American College of Cardiology/American Heart Association*< 130/80< 130/80< 130/80< 130/80
2017 American College of Physicians and American Academy of Family PhysiciansN/A< 150/90< 150/90< 150/90
2014 Eighth Joint National Committee< 140/90< 150/90< 150/90< 150/90

*—Lower targets are reasonable based on clinical judgment and patient preferences or values
†—A target of less than 140/90 mm Hg is recommended for patients with chronic kidney disease.
‡—Recommendation is to treat all patients to less than 140/90 mm Hg but states it is optimal to treat persons younger than 65 years and people with coronary artery disease, chronic kidney disease, heart failure, previous stroke, chronic obstructive pulmonary disease, or diabetes mellitus to less than 130/80 mm Hg (less than 140/80 mm Hg in older patients).
§—Recommendation is to transition from target of 130/80 mm Hg to 140/90 mm Hg at 65 years of age.
||—A target of less than 140/90 mm Hg is recommended in patients with diabetes.
¶—Recommendation is to treat all patients 18 to 59 years of age (including those with diabetes) to a systolic blood pressure target of less than 130 mm Hg. For patients 30 years and older, a diastolic blood pressure target of less than 90 mm Hg is recommended.

That concludes our Guidelines Spotlight on Blood Pressure Targets in Adults With Hypertension. Sign up for alerts and stay informed on the latest published guidelines and articles.

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