ABSTRACT
Blood pressure goals The rst step in treating hypertension is to assign a target or goal blood pressure to the patient. This is a complex task because the various guidelines suggest different values. Furthermore, blood pressure norms change within each guideline depending on the published version and on comorbid conditions (i.e., diabetes or kidney disease). Two well-accepted guidelines are from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure from the United States (JNC 7)1; and the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).2 The JNC 7 is more simple and direct, although the ESH/ESC, which more meticulously denes cardiovascular risk, is better tailored to the individual despite being more complex. Both recent guidelines suggest lowering ofce blood pressure to <140/90 mm Hg in otherwise healthy adults, but to <130/80 mm Hg in those with diabetes, renal disease, or cardiovascular disease. However, as white-coat hypertension and white-coat effect are quite common, affecting up to 20% of people with elevated blood pressure,3 the use of out-of-ofce measurements with ambulatory or home blood pressure devices is also suggested. Out-of-ofce blood pressure monitoring is shown to more accurately predict cardiovascular risk2 and these techniques are gaining popularity. Home blood pressure monitoring is the preferred method in my practice, because it further engages my patients in their care. However, it is used with caution by suggesting only proper and validated devices and avoiding use in people with arrhythmias, as these devices may then be inaccurate. Although not absolutely necessary, it is good practice to check the home blood pressure monitor against an in-ofce measurement prior to use and periodically thereafter. The 24-hour ambulatory device is also useful because it records values during sleep, which is an important component in ascertaining the cardiovascular risk. However, it is expensive, often not covered by medical insurance, and only represents one day of a person’s life. Most blood pressure guidelines suggest comparative values for out-of-ofce devices
with in-ofce values. Table 9.1 outlines the various blood pressure goals for the JNC 7 and the more recent ESH/ESC guidelines.
