SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the [...] by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.)

• In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.)

However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension.

In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above.

• In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.)

• In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.)

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the [...] by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.)

• In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.)

However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension.

In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above.

• In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.)

• In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.)