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In this position statement the British and Irish Hypertension Society (BIHS) present a review of the current evidence for blood pressure (BP) treatment thresholds and targets. The BIHS recommend initiating pharmacological antihypertensive therapy, irrespective of cardiovascular disease risk, following a confirmed diagnosis of hypertension (sustained out-of-office BP ≥ 135/85 mmHg despite diet and lifestyle advice). The BIHS recommend an on-treatment BP target < 130/80 mmHg or as low as reasonably achievable without causing unacceptable side-effects, within 6-months of initiating treatment, for all adults. Possible subgroups to whom this may not apply are those who are frail and/or have limited life expectancy where higher targets may be appropriate based on clinical judgement and the individuals' tolerance to treatment. The BIHS believe that this simple 2-step approach will facilitate practitioners deliver evidence-based best practice, discourage therapeutic inertia around BP lowering and improve heath outcomes for all adults living with high BP.