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For most people, recommendations are to reduce blood pressure to less than or equal to somewhere between 140/90 mmHg and 160/100 mmHg. [2] In general, for people with elevated blood pressure, attempting to achieve lower levels of blood pressure than the recommended 140/90 mmHg will create more harm than benefits, [3] in particular for older people. [4]
The modern history of hypertension begins with the understanding of the cardiovascular system based on the work of physician William Harvey (1578–1657), who described the circulation of blood in his book De motu cordis. The English clergyman Stephen Hales made the first published measurement of blood pressure in 1733.
Mean blood pressure rises from early adulthood, plateauing in mid-life, while pulse pressure rises quite markedly after the age of 40. Consequently, in many older people, systolic blood pressure often exceeds the normal adult range, [33] if the diastolic pressure is in the normal range this is termed isolated systolic hypertension.
Guidelines on the choice of agents and how best to step up treatment for various subgroups in hypertension (high blood pressure) have changed over time and differ between countries. A Comparison of International Guidelines on Goal Blood Pressure and Initial Therapy for Adults With Hypertension (adapted from JNC 8 guidelines [ 1 ] )
For most adults, normal blood pressure at rest is within the range of 100–140 millimeters mercury (mmHg) systolic and 60–90 mmHg diastolic. [6] [7] For most adults, high blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg. [5] [6] [7] Different numbers apply to children. [14]
For mild blood pressure elevation, consensus guidelines call for medically supervised lifestyle changes and observation before recommending initiation of drug therapy. However, according to the American Hypertension Association, evidence of sustained damage to the body may be present even prior to observed elevation of blood pressure.
Using the results of the blood pressure test, the health care provider will diagnose prehypertension or high blood pressure if: For an adult, systolic or diastolic readings are consistently higher than 120/80 mmHg. A child's blood pressure numbers are outside average numbers for children of the same age, gender, and height. [40]
In 2018, HHS released an update to the first set of guidelines. This 2018 edition provides guidelines for people aged three years and older and summarizes the new knowledge gained from studies that were conducted since the first edition was released in 2008. These Guidelines can be tailored to meet individual interests, lifestyles, and goals.
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