When to start blood pressure-lowering therapy

National Heart Foundation of Australia (NHFA), 2016 Whelton, 2018 Williams, 2018

The decision to start blood pressure–lowering therapy should consider both the patient’s actual blood pressure (BP) and their atherosclerotic cardiovascular disease (ASCVD) risk estimate to determine the harm–benefit balance of treatment—see Atherosclerotic cardiovascular disease risk estimation for more information and a link to the Aus CVD risk calculator. A patient with a high ASCVD risk estimate or established ASCVD is more likely to benefit from BP-lowering therapy than a patient with a similar BP and low ASCVD risk estimate. Recommendations for when to start BP-lowering therapy according to ASCVD risk estimate are outlined below. For patients in whom the Aus CVD risk calculator is not validated (eg in an adult younger than 45 years), the decision to start BP-lowering drug therapy requires clinical judgement.

All patients with elevated BP should be encouraged to adopt lifestyle modification measures to reduce both BP and ASCVD risk; see Nondrug management of elevated BP.

For patients with consistently significantly elevated BP (systolic BP 160 mmHg or more; diastolic BP 100 mmHg or more), start drug therapy irrespective of the patient’s ASCVD risk estimate.