{"id":9346,"date":"2025-12-09T14:27:25","date_gmt":"2025-12-09T11:27:25","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=9346"},"modified":"2025-12-09T14:27:25","modified_gmt":"2025-12-09T11:27:25","slug":"bihs-2025-position-statement-on-bp-treatment-thresholds-and-targets","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/bihs-2025-position-statement-on-bp-treatment-thresholds-and-targets\/","title":{"rendered":"BIHS 2025 Position Statement on BP Treatment Thresholds and Targets"},"content":{"rendered":"
BIHS 2025 Position Statement on BP Treatment Thresholds and Targets<\/div>\n
<\/div>\n
Source: Hypertension News, ISH \u2013 December 2025<\/div>\n
<\/div>\n
Key Concepts & Updates<\/div>\n
<\/div>\n
1.\u2060 \u2060Shift Toward More Aggressive BP Treatment<\/div>\n
\u2022 The British and Irish Hypertension Society (BIHS) is the latest to call for lower treatment thresholds and tighter BP targets.<\/span><\/div>\n
\u2022 New treatment threshold: \u2265135\/85 mmHg for diagnosing hypertension (regardless of BP measurement method).<\/span><\/div>\n
\u2022 New treatment target: <130\/80 mmHg for all hypertensive patients, irrespective of risk category or measurement method.<\/span><\/div>\n
\u2022 This marks a significant shift aligning with a global trend toward earlier and more intensive BP management.<\/span><\/div>\n
<\/div>\n
2.\u2060 \u2060Evidence Supporting Lower BP Targets<\/div>\n
<\/div>\n
SPRINT trial (2015)<\/div>\n
\u2022 Demonstrated that targeting SBP <120 mmHg significantly reduces major cardiovascular events across adults \u226550 years.<\/span><\/div>\n
\u2022 Compared to traditional targets (140\/90 mmHg), intensive control had a clear benefit.<\/span><\/div>\n
<\/div>\n
New Chinese trials confirming benefits of lower SBP targets:<\/div>\n
<\/div>\n
STEP Trial (2021)<\/div>\n
\u2022 8,511 patients aged 60\u201380 yrs.<\/span><\/div>\n
\u2022 Compared SBP target 110\u2013130 mmHg vs. 130\u2013150 mmHg.<\/span><\/div>\n
\u2022 Intensive treatment reduced major CV events (HR 0.74, CI 0.60\u20130.92).<\/span><\/div>\n
<\/div>\n
ESPRIT Trial (2024)<\/div>\n
\u2022 11,255 adults \u226550 yrs with high CV risk (diabetes, stroke history).<\/span><\/div>\n
\u2022 Compared SBP <120 mmHg vs. <140 mmHg.<\/span><\/div>\n
\u2022 Intensive control reduced MACE (HR 0.88, CI 0.78\u20130.99) over 3.4 years.<\/span><\/div>\n
<\/div>\n
BPROAD Trial (2024\u20132025)<\/div>\n
\u2022 12,821 adults \u226550 yrs with type 2 diabetes.<\/span><\/div>\n
\u2022 Compared SBP <120 mmHg vs. <140 mmHg.<\/span><\/div>\n
\u2022 Intensive target significantly reduced MACE (HR 0.79, CI 0.69\u20130.90) across ~5 years.<\/span><\/div>\n
<\/div>\n
3.\u2060 \u2060Rationale for Lower Diagnosis Threshold (\u2265135\/85 mmHg)<\/div>\n
\u2022 Applies regardless of office, home, or ambulatory BP method.<\/span><\/div>\n
\u2022 Similar to the 2017 ACC\/AHA reclassification, which instantly labeled 13% more US adults as hypertensive (~30 million individuals).<\/span><\/div>\n
\u2022 Newly reclassified patients tend to be younger (<45 yrs).<\/span><\/div>\n
\u2022 Expected consequences:<\/span><\/div>\n
\u2022 Higher healthcare utilization<\/span><\/div>\n
\u2022 More medication prescriptions<\/span><\/div>\n
\u2022 Increased risk of adverse effects in low-risk populations<\/span><\/div>\n
<\/div>\n
Measurement consistency concerns<\/div>\n
\u2022 Studies show modest reproducibility between office, home, and ambulatory BP.<\/span><\/div>\n
\u2022 Variability decreases at lower BP ranges (SBP 120s).<\/span><\/div>\n
\u2022 Cost-effectiveness models indicate that intensive targets remain cost-effective even with measurement errors.<\/span><\/div>\n
<\/div>\n
4.\u2060 \u2060One Target for All: Simplification or Overtreatment?<\/div>\n
<\/div>\n
Benefits of unified thresholds\/targets<\/div>\n
\u2022 Simplifies clinical practice.<\/span><\/div>\n
\u2022 Reduces therapeutic inertia.<\/span><\/div>\n
\u2022 Aligns with trial evidence showing:<\/span><\/div>\n
\u2022 \u201cLower is better\u201d across subgroups:<\/span><\/div>\n
\u2022 Prior CVD<\/span><\/div>\n
\u2022 Diabetes<\/span><\/div>\n
\u2022 Stroke<\/span><\/div>\n
\u2022 CKD<\/span><\/div>\n
\u2022 Elderly<\/span><\/div>\n
<\/div>\n
Potential harms<\/div>\n
\u2022 Clinical trials mainly included adults >50 yrs at moderate\/high risk.<\/span><\/div>\n
\u2022 Applying them to young adults (e.g., 26-year-old with BP 138\/85 and ~2% 10-yr CV risk) may lead to:<\/span><\/div>\n
\u2022 Questionable benefit<\/span><\/div>\n
\u2022 10 years of medication to reduce absolute risk from 2% \u2192 1.4%<\/span><\/div>\n
\u2022 Raises ethical questions of overtreatment in low-risk individuals.<\/span><\/div>\n
<\/div>\n
5.\u2060 \u2060Global Trend Toward Aggressive Management<\/div>\n
\u2022 BIHS recommendations reflect broader global movement toward:<\/span><\/div>\n
\u2022 Earlier treatment<\/span><\/div>\n
\u2022 Lower BP targets<\/span><\/div>\n
\u2022 Streamlined decision-making<\/span><\/div>\n
\u2022 Potential population-level benefits:<\/span><\/div>\n
\u2022 Lives saved<\/span><\/div>\n
\u2022 Reduced healthcare costs<\/span><\/div>\n
\u2022 But need to balance simplification with personalized care, especially using modern decision-support tools.<\/span><\/div>\n
<\/div>\n
6.\u2060 \u2060Table of BP Targets Across Global Guidelines (Page 5)<\/div>\n
<\/div>\n
\u2022 The 2025 BIHS recommendations endorse a unified blood pressure target of <130\/80 mmHg for all adults with hypertension.<\/span><\/div>\n
\u2022 The ACC\/AHA (2017 and 2025 updates) similarly recommend achieving <130\/80 mmHg regardless of baseline cardiovascular risk.<\/span><\/div>\n
\u2022 The 2025 Hypertension Canada guidelines focus primarily on systolic blood pressure, recommending a target of <130 mmHg, without specifying a diastolic BP target.<\/span><\/div>\n
\u2022 The ESC\/EAC 2024 guidelines advise that the optimal blood pressure range for most individuals is SBP 120\u2013129 mmHg and DBP 70\u201379 mmHg.<\/span><\/div>\n
\u2022 They also note that <120\/70 mmHg represents an \u201coptimal research target\u201d achieved under controlled trial conditions, not necessarily a universal clinical goal.<\/span><\/div>\n
\u2022 The ESH 2023 guidelines initially recommend reducing BP to <140\/80 mmHg for most adults.<\/span><\/div>\n
\u2022 If well tolerated, clinicians should aim for <130\/80 mmHg in adults up to approximately 79 years of age.<\/span><\/div>\n
\u2022 Systolic BP 120\u2013129 mmHg may be considered for some patients but not below 120 mmHg.<\/span><\/div>\n
\u2022 The ISH 2020 guidelines recommend a target of <130\/80 mmHg for adults younger than 65 years, if tolerated.<\/span><\/div>\n
\u2022 For older adults or those with frailty, less stringent targets are advised, typically <140\/90 mmHg, or <140\/80 mmHg for selected elderly patients.<\/span><\/div>\n
\u2022 All guideline bodies emphasize that targets should be individualized upward when lower BP levels are not tolerated\u2014especially in frail elderly patients\u2014to achieve the lowest safe and clinically reasonable blood pressure.<\/span><\/div>\n
Guidelines advise higher\/lower targets if needed for frailty or intolerance.<\/div>\n
<\/div>\n
\u00a07. References Included in the Article<\/div>\n
\u2022 Eight major references listed, including SPRINT (2015), STEP (2021), ESPRIT (2024), BPROAD (2025), ACC\/AHA 2017 guidelines, and meta-analyses on BP measurement reliability.<\/span><\/div>\n
<\/div>\n
8.\u2060 \u2060ISH Membership Promotion (Page 6)<\/div>\n
\u2022 Invitation to join the International Society of Hypertension with membership categories:<\/span><\/div>\n
\u2022 Member<\/span><\/div>\n
\u2022 Associate Member<\/span><\/div>\n
\u2022 Trainee<\/span><\/div>\n
\u2022 Website: https:\/\/ish-world.com\/join-ish\/<\/span><\/div>\n
<\/div>\n
(Taken from Hypertension News \u2013 December 2025, International Society of Hypertension)<\/div>\n
<\/div>\n
https:\/\/ish-world.com\/document\/1764854170.pdf<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

BIHS 2025 Position Statement on BP Treatment Thresholds and Targets Source: Hypertension News, ISH \u2013 December 2025 Key Concepts & Updates 1.\u2060 \u2060Shift Toward More Aggressive BP Treatment \u2022 The British and Irish Hypertension Society (BIHS) is the latest to call for lower treatment thresholds and tighter BP targets. \u2022 New treatment threshold: \u2265135\/85 mmHg […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9346","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9346","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=9346"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9346\/revisions"}],"predecessor-version":[{"id":9347,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9346\/revisions\/9347"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=9346"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=9346"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=9346"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}