Purpose: To review the evidence and provide clinical recommendations for appropriate blood pressure treatment targets for adults with hypertension.

Methods: This guideline is based on a systematic review of randomized controlled trials (RCTs) from database inception to May 2019. The target audience for the guideline includes all primary care clinicians, including family physicians, and the target patient population includes adults who have hypertension with or without cardiovascular disease (CVD). The panel defined patients as having hypertension when their blood pressures routinely measured higher than 140/90 mm Hg. This guideline was developed using a modified version of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, a transparent approach to evaluating the certainty of the evidence and determining the strength of recommendations.

Recommendation 1: The American Academy of Family Physicians (AAFP) strongly recommends clinicians treat adults who have hypertension to a standard blood pressure target (less than 140/90 mm Hg) to reduce the risk of all cause and cardiovascular mortality (strong recommendation; high-quality evidence). Treating to a lower blood pressure target (less than 135/85 mm Hg) did not provide additional benefit at preventing mortality; however, a lower blood pressure target could be considered based on clinical assessment and patient preferences and values.