Tag Archives: BP target

Update on Blood Pressure control – What should be the target value?

Latest updates from American Medical association on Hypertension target.

Hypertension – commonly referred as high blood pressure is one of the commonest chronic conditions worldwide. Hypertension is referred to as the ‘silent killer’. This is because it may not manifest with usual signs and symptoms. If not controlled properly, this can lead to harmful effects. These include – heart diseases (Coronary artery disease, enlarged left heart or left ventricular hypertrophy and heart failure), effects on brain (Dementia, memory loss and stroke) and damage to kidneys (Kidney failure, glomerulosclerosis and kidney artery aneurysm).
Hypertension affecst 1 of every 3 Americans. Yet only over half (54%) of those affected have their pressure under control.

High blood pressure is preventable with active monitoring and timely treatment.

What is the optimal blood pressure and when should you seek help

Till date, (Based on JNC 7 report) the target BP was set at 140/90 for most people regardless of age except those with certain conditions. These conditions include diabetes, chronic kidney diseases and some heart conditions where it was recommended to keep blood pressure lower than 130/80.

JAMA (Journal of the American Medical Association) recently published its viewpoint on this supported by recent studies.
This table summarizes Blood Pressure goal recommended by JAMA

JAMA recommendations

Note that the target for general population is set at 120/80 as many studies have shown a tremendous increase in heart conditions above these levels. One should not start with medications in this age group as lifestyle changes are the first choice of control in this age group. These changes include weight loss, proper diet, reduction in salt intake, limiting alcohol and smoking and reducing your stress levels.

For the age group of 50-74, the goal is set at 130 for systolic blood pressure but JAMA notes that a target of less than 140 is reasonable. One should aim for less than 130 if treatment is well tolerated.

For the higher age bracket (more than 74) it is recommended to set the goal at 140. Again treatment should be adjusted based on tolerance including orthostatic hypotension, renal function and cognitive changes.

Hypertension and Mobility

While many studies looked at the effect of blood pressure control on cardiovascular and renal conditions, a recent study looked at the effect of intensive control on mobility. The authors followed 2636 patients over 3 years. They looked at limitation in mobility – defined as a walking speed less than 0.6 meters per second (m/s) or self assessed limitation in walking and climbing stairs. The result was that ‘Intensive blood pressure control does not appear to have an important effect on short-term gait speed decline among older adults.’

Recommendation for Physicians

American medical association recommends physicians to use the M.A.P framework as an approach to control blood pressure.
M – Measure Blood pressure accurately
A  – Act rapidly to address high BP
P  – Partner with patients and families to encourage self management.

Controlling your blood pressure starts with taking control of your lifestyle and can control many other diseases. Post a free question to ask our doctors how you can help yourself to a healthier tomorrow.

References
Hypertension in 2017—What Is the Right Target?Aram V. Chobanian, MD -JAMA.  Published online January 30, 2017. doi:10.1001/jama.2017.0105

Effect of Intensive Blood Pressure Control on Gait Speed and Mobility Limitation in Adults 75 Years or OlderA Randomized Clinical Trial Michelle C. Odden, PhD et al Published online February 6, 2017. doi:10.1001/jamainternmed.2016.9104