Hypertension: Target Blood Pressure Levels - …

1 hypertension : Target Blood Pressure Levels Reference # 239 - 1 - hypertension : Target Blood Pressure Levels Key Highlights from the Recommended Guideline Aim for a Blood Pressure < 140/90 mm Hg (< 130/80 mm Hg in patients with diabetes or renal disease) Prioritize control of systolic Blood Pressure , a much stronger cardiovascular risk factor than diastolic Blood Pressure Scope: Health professionals involved in the care of adults who have or are at risk for hypertension What are the benefits of lowering Blood Pressure ?

2 Treat hypertension in order to reduce(1) stroke by 35% 40%; (2) myocardial infarction by 20% 25 %, and (3) heart failure by >50 %. [Level of Evidence: M] What Blood pressures should I aim for when treating my patients with hypertension ? Aim for a Target Blood Pressure < 140/90 mm Hg in most patients to decrease cardiovascular complications. [Level of Evidence: RA] Aim for <130/80 mm Hg in patients with diabetes or renal disease. [Level of Evidence: PR] Focus on systolic rather than diastolic Blood Pressure , because: o Systolic Blood Pressure is a stronger cardiovascular risk factor than diastolic Blood Pressure in patients over 50 years old.

3 [Level of Evidence: F] o Poor control of systolic Blood Pressure is a key factor in poor overall Blood Pressure control. [Level of Evidence: X, F] hypertension : Target Blood Pressure Levels - 2 - Reference # 239 Should I be concerned about pre- hypertension (120-129/80-89 mm Hg) in patients without diabetes or renal disease? Should I be concerned about pre- hypertension (120-129/80-89 mm Hg) in patients without diabetes or renal disease? Be aware that patients with pre- hypertension are at high risk for developing frank hypertension .

4 [Level of Evidence: Not stated] Be aware that patients with pre- hypertension are at high risk for developing frank hypertension . [Level of Evidence: Not stated] Aim to decrease the later development of hypertension . [Level of Evidence: Not stated] Aim to decrease the later development of hypertension . [Level of Evidence: Not stated] Focus on lifestyle modifications to reduce the risk of later hypertension . [Level of Evidence: Not stated] Focus on lifestyle modifications to reduce the risk of later hypertension . [Level of Evidence: Not stated] Do not use antihypertensive drug treatment.

5 [Level of Evidence: Not stated] Do not use antihypertensive drug treatment. [Level of Evidence: Not stated] Levels of Evidence Levels of Evidence The Levels of evidence used to grade the recommendations in this guideline are as follows: The Levels of evidence used to grade the recommendations in this guideline are as follows: Level M Level M Meta-analysis; use of statistical methods to combine the results from clinical trials Meta-analysis; use of statistical methods to combine the results from clinical trials Level RA Randomized controlled trials; also known as experimental studies Level RE Retrospective analyses.

6 Also known as case-control studies Level F Prospective study; also known as cohort studies, including historical or prospective follow-up studies Level X Cross-sectional surveys; also known as prevalence studies Level PR Previous review or position statements Level C Clinical interventions (nonrandomized) The above recommendations were derived from the following GAC endorsed guideline: National Heart, Lung, and Blood Institute. (2003, May). The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high Blood Pressure : The complete report.

7 Retrieved November 20, 2007 from: Rating (out of 4): Endorsed Date: September 2005 Planned Review Date: September 2008 Ontario Guidelines Advisory Committee 500 University Ave., Suite 650, Toronto, ON M5G 1V7 Telephone: 1-888-512-8173 Fax: 416-971-2462 Email.