Treatment and Targets

When to initiate pharmacological treatment and recommended targets

Use this interactive tool to determine if your patient exceeds the threshold values for initiation of pharmacological treatment and to determine recommended treatment targets

How old is the patient?

  years

Does the patient have diabetes?

Yes No

Does the patient have target organ damage (TOD) or cardiovascular (CV) risk factors?

Yes No

Measure patient’s blood pressure and enter test results:

  mm Hg
  mm Hg

Calculate
Calculate

Do not start treatment

Patient does not exceed the usual blood pressure threshold for initiation of pharmacological treatment

Consider pharmacological treatment

Patient exceeds the usual blood pressure threshold for initiation of pharmacological treatment

 

Recommended treatment target is:

SBP<130 and DBP<80

Consider pharmacological treatment

Patient exceeds the usual blood pressure threshold for initiation of pharmacological treatment

 

Recommended treatment target is:

SBP<140 and DBP<90

Consider pharmacological treatment

Patient exceeds the usual blood pressure threshold for initiation of pharmacological treatment *

 

Recommended treatment target is:

SBP<150 (DBP = N/A)

 

* The BP threshold value for very elderly is SBP≥160. This higher treatment target for the very elderly reflects current evidence and heightened concerns of precipitating adverse effects, particularly in frail patients. Decisions regarding initiating and intensifying pharmacotherapy in the very elderly should be based upon an individualized risk-benefit analysis.

There are conflicting treatment recommendations in this case

Treatment threshold and targets should be individualized taking into account desired aggressiveness of therapy, risk of future cardiovascular events, frailty and likelihood of adverse effects.

 

Recommended treatment target is:

As this patient has diabetes, a recommended treatment target of <130/80 mm Hg can be followed.

 

As this patient is very elderly (age 80 years or greater), a >160 mmHg threshold for initiation of pharmacotherapy and a <150 mmHg treatment target could be followed.

 

*Caution*: In patients with coronary artery disease be cautious when lowering blood pressure if diastolic blood pressures are < 60 mmHg

Note: All patients with known or suspected hypertension should optimize health behaviours

TABLE 1. Usual blood pressure threshold values for initiation of pharmacological treatment

Population SBP ≥ DBP ≥
Diabetes 130 80
High risk (TOD or CV risk factors) 140 90
Low risk (no TOD or CV risk factors) 160 100
Very elderly* (≥ 80 yrs.) 160 NA
*This higher treatment target for the very elderly reflects current evidence and heightened concerns of precipitating adverse effects, particularly in frail patients. Decisions regarding initiating and intensifying pharmacotherapy in the very elderly should be based upon an individualized risk-benefit analysis.

TABLE 2. Recommended Treatment Targets

Population SBP < DBP <
Diabetes 130 80
All others < 80 yrs. (including CKD) 140 90
Very elderly (≥ 80 yrs.) 150 NA
In patients with coronary artery disease be cautious when lowering blood pressure if diastolic blood pressures are < 60 mmHg
The content and recommendations presented on this page is only intended to be used as a decision support tool. All guideline tools and resources provided by Hypertension Canada are intended for educational and informational purposes only and individualized clinical correlation is required.