## NPCDCS Blood Pressure Control Targets **Key Point:** The NPCDCS adopts a **risk-stratified approach** to BP targets: **<140/90 mmHg** for uncomplicated hypertension, but **<130/80 mmHg** for patients with **diabetes mellitus** or **chronic kidney disease (CKD)** to reduce cardiovascular and renal complications. ### Rationale for Differentiated Targets | Patient Category | BP Target | Rationale | | --- | --- | --- | | **Uncomplicated hypertension** | <140/90 mmHg | Balances cardiovascular benefit with avoiding over-treatment; supported by major trials (ACCORD, SPRINT subset analysis) | | **Hypertension + Diabetes** | <130/80 mmHg | Tighter control reduces proteinuria, slows diabetic nephropathy, and reduces MI/stroke risk | | **Hypertension + CKD** | <130/80 mmHg | Lower BP targets slow GFR decline and reduce albuminuria progression | | **Hypertension + CAD/Prior MI** | <130/80 mmHg | Secondary prevention; reduces recurrent events | | **Elderly (≥60 years) without comorbidity** | <140/90 mmHg | HYVET trial: <140/80 mmHg reduces stroke; <150/90 mmHg is acceptable if tolerating lower targets poorly | **High-Yield:** The NPCDCS guideline **does NOT recommend <130/80 mmHg universally** for all patients because: 1. Increased risk of hypotensive symptoms and falls in elderly 2. J-curve phenomenon: excessive BP lowering may increase MI risk in some populations 3. Cost and complexity of achieving <130/80 mmHg in resource-limited settings **Clinical Pearl:** **Diabetes and CKD are the two key comorbidities that lower the BP target** under NPCDCS. Presence of either mandates stricter control. **Mnemonic:** **DCK-130** — Diabetes, CKD → target <130/80 mmHg; otherwise <140/90 mmHg.
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