View source for Chronic hypertension medical therapy blood pressure goals of treatment

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{{Chronic hypertension}}
{{CMG}}; '''Deputy Editor-In-Chief ''' {{RGB}}

The 24-hour ambulatory systolic pressure may better  mortality than the daytime systolic blood pressure.

Regarding the accuracy of office oscillometric and home blood pressure monitoring compared with ambulatory blood pressure monitoring, a meta-analysis by the Rational Clinical Examination found<ref name="pmid34313682">{{cite journal| author=Viera AJ, Yano Y, Lin FC, Simel DL, Yun J, Dave G | display-authors=etal| title=Does This Adult Patient Have Hypertension?: The Rational Clinical Examination Systematic Review. | journal=JAMA | year= 2021 | volume= 326 | issue= 4 | pages= 339-347 | pmid=34313682 | doi=10.1001/jama.2021.4533 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34313682  }} </ref>:
* Office pressures (presumably attended by medical personnel) has sensitivity and specificity of 51% and 88%
* Home monitoring has sensitivity and specificity of 75% and 76%

Elevated high-sensitivity cardiac troponin T (hscTnT) and N-terminal pro-B-type natriuretic peptide (NTproBNP) levels may help guide treatment.

The decision to treat may be affected by projected longevity of a patient<ref name="pmid35532917">{{cite journal| author=Chen T, Shao F, Chen K, Wang Y, Wu Z, Wang Y | display-authors=etal| title=Time to Clinical Benefit of Intensive Blood Pressure Lowering in Patients 60 Years and Older With Hypertension: A Secondary Analysis of Randomized Clinical Trials. | journal=JAMA Intern Med | year= 2022 | volume=  | issue=  | pages=  | pmid=35532917 | doi=10.1001/jamainternmed.2022.1657 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35532917  }} </ref>:
* "for patients 60 years and older with hypertension, intensive BP treatment may be appropriate for some adults with a life expectancy of greater than 3 years
* "but may not be suitable for those with less than 1 year."

==Clinical practice guidelines==
Recommendations for treatment goals from recent [[clinical practice guideline]]s are tabulated below. However, treated based on underlying risk rather than a blood pressure target may be more effective. The logic supporting a target of 130/80 mm Hg has been disputed and the Cochrane Collaboration found insufficient evidence to determine a treatment goal for adults or adults over 65 years of age.

If the goal is 130/80, proper measurement includes (distilled from Table 8 of the ACC/AHA guidelines, executive summary):
* having the patient sit quietly for 5 minutes before a reading is taken
* supporting the limb used to measure BP
* ensuring the BP cuff is at heart level
* using the correct cuff size
* for auscultatory readings, deflating the cuff slowly
* the timing of BP measurements in relation to ingestion of the patient’s medication should be standardized
* a single reading is inadequate for clinical decision-making. An average of 2 to 3 BP measurements obtained on 2 to 3 separate occasions will minimize random error and provide a more accurate basis for estimation of BP.

If the above measurement methods are not use, a preliminary study from [https://thrive.kaiserpermanente.org/care-near-you/northern-california/ Kaiser Northern California] suggests a target of 140 mm Hg.

{| class="wikitable"
|+ AHA vs Roerecke estimates of relationship between routine, auscultated BP measurement and gold standard ambulatory measurement.
! Clinic (routine)
AHA, 2017