High blood pressure or hypertension is a huge topic. Today, we’re going to address what targets we should have for blood pressure treatment.
The British guidelines, published by NICE in 2019, suggest that for patients under the age of 80, we should have a clinic blood pressure of less than 140 over 90 mmHg or a home blood pressure of less than 135 over 85 mmHg. The limits are a little bit more lenient if you’re over 80.
This is quite different to guidelines from the US and Europe.
American guidelines suggest we should have a target blood pressure of less than 130 / 80 mmHg. Whereas the European Society of Cardiology recommend a systolic blood pressure target of 120 to 129 mmHg.
So these are all quite different targets.
The most recent large trial data come from the Sprint study, which is a randomised controlled trial of intensive versus standard blood pressure control that was published in the New England Journal of Medicine in November 2015.
They looked at 9,361 people, with a blood pressure of 130 mmHg or higher and had a target of less than 120 mmHg as intensive arm or a target of less than 140 mmHg as a standard arm.
They found that, after three years, there was a significantly lower rate of myocardial infarction, coronary artery syndromes, stroke, heart failure or death from cardiovascular causes in the intensive arm. There was also a reduction in all-cause mortality in the intensive arm.
Therefore, there is good data that we should be treating blood pressure to a lower target than the British guidelines.
The problem is that this increases the risk of side effects, increases the number of visits to the doctor as well as the pill burden of people with high blood pressure.
This is worth a discussion and working with your doctor to make sure that you can get a regimen that works for you and a target that you are happy with.