A 70-year-old diabetic woman with CKD (eGFR 35 mL/min) and an uncomplicated history is found to have BP 155/90 mmHg on repeat measurements. Per ACC/AHA 2017 hypertension guidelines, the recommended BP target for this patient is:

• A < 150/90 mmHg (relaxed target for age >65)
• B < 130/80 mmHg ✓
• C < 140/90 mmHg (standard target for CKD+diabetes)
• D < 120/80 mmHg (SPRINT trial target)

Explanation

The ACC/AHA 2017 hypertension guidelines recommend a BP target of <130/80 mmHg for most adults with hypertension, including those with diabetes, CKD (stages 1-5 including dialysis), established CVD, or high cardiovascular risk. This represents a tightening from the earlier JNC 8 recommendation of <140/90 mmHg for diabetics and <140/90 mmHg for CKD. The SPRINT trial (systolic target <120 mmHg) showed further CV mortality benefit but at a cost of increased adverse events; <120/80 mmHg is therefore not a universal guideline target. For patients ≥65 years without diabetes or high risk, community-dwelling adults, <130/80 mmHg is still recommended if tolerated.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.