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Goal blood pressure thresholds from different society guidelines according to underlying comorbidity

Goal blood pressure thresholds from different society guidelines according to underlying comorbidity
Underlying comorbidity ACC/AHA[1] ESC/ESH[2] CHEP[3] NHFA[4] JHS[5] NICE[6] ACP/AAFP[7] ADA[8] KDIGO[9]
Established atherosclerotic cardiovascular disease* <130/80 <130/80 <120/80 <120/80 <130/80 <140/90      
Heart failure <130/80 <130/80 <120/80 <120/80 <130/80 <140/90      
Diabetes mellitus <130/80 <130/80 <130/80 <120/80 <130/80 <140/90   <140/90  
Chronic kidney disease <130/80 <130/80 <120/80 <120/80 <130/80 <140/90     <120/80
High cardiovascular riskΔ <130/80 <130/80 <120/80 <120/80 <130/80 <140/90      
Older adults◊ <130/80 <130/80 <120/80 <120/80 <140/90 <140/90 <150/90§    
No comorbidity <130/80 <130/80 <140/90 <140/90 <130/80 <140/90      
All targets listed are predicated on therapy being well tolerated. (In general, if a patient cannot tolerate the target blood pressure, then the target must be adjusted upward.)
All values are in mmHg. All targets assume that blood pressure is monitored optimally (eg, with standardized office measurement, automated oscillometric blood pressure monitoring).
ACC/AHA: American College of Cardiology/American Heart Association; ESC/ESH: European Society of Cardiology/European Society of Hypertension; CHEP: Canadian Hypertension Education Program; NHFA: National Heart Foundation of Australia; JHS: Japanese Hypertension Society; NICE: National Institute for Health and Care Excellence (United Kingdom); ACP/AAFP: American College of Physicians/American Academy of Family Physicians; ADA: American Diabetes Association; KDIGO: Kidney Disease Improving Global Outcomes; MI: myocardial infarction.
* Established atherosclerotic cardiovascular disease includes patients with prior MI, stroke, and peripheral artery disease.
¶ ADA suggests a lower target (<130/80) mmHg in patients with diabetes at high cardiovascular risk.
Δ Defined as an elevated calculated 10-year risk of having an atherosclerotic cardiovascular event; "elevated" in this context often means ≥10 or ≥15% 10-year risk.
◊ CHEP and JHS define older adults as ≥75 years, ACP/AAFP defines older adults as ≥60 years, and other societies define older adults as ≥65 years.
§ ACP/AAFP suggests a target of <140/90 mmHg in older adults with high cardiovascular risk.
References:
  1. 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 Practice Guidelines. Hypertension 2018; 71:e13.
  2. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021.
  3. Nerenberg KA, Zarnke KB, Leung AA, et al. Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. Can J Cardiol 2018; 34:506.
  4. Gabb GM, Mangoni AA, Anderson CS, et al. Guideline for the diagnosis and management of hypertension in adults - 2016. Med J Aust 2016; 205:85.
  5. Umemura S, Arima H, Arima S, Asayama K, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertension Res 2019; 42:1235.
  6. Hypertension in adults: Diagnosis and management. National Institute for Health and Care Excellence (NICE). Available at http://www.nice.org.uk/guidance/ng136 (Accessed April 19, 2021).
  7. Qaseem A, Wilt TJ, Rich R, et al. 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. Ann Intern Med 2017; 166:430.
  8. American Diabetes Association. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44:S125.
  9. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int 2021; 99:S1.
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