SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method 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) [...] (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 method 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) [...] (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.)