It means to get the blood pressure into "normal" or "safe" values as quickly as safely possible and maintain these lower blood pressures once there. Doing this for  everyone who has clinically defined hypertension is the aim as this classification of blood pressure is associated with significantly increased risks of cardiovascular events. Generally this would be to get the BP

Hi Anil, "Aggressive" lowering of BP is a crisis-style intervention of strong treatment, believed necessary when very high BP threatens wellbeing, especially as it may cause death through stroke, heart attack, or possibly seizures or other causes. Achieving this lowering of BP from high to okay levels is usually managed by administration of pharmaceutical drugs. This is for acute cases, to allow a patient to go on living, rather than teetering on the brink of death. However, your understanding that some people need lower BP than others is not strictly correct (although it may indeed be interpreted differently among various practitioners) - but actually we all need BP within a normal range to maintain health in the long-term. In medical terms, this means that people with high BP will be prescribed drugs, on an ongoing basis to address their chronic health problems. If they have very high BP, they will be prescribed higher doses, and may be supervised for a short time in hospital. There are some complementary medicines which may help to reduce elevated BP (including simple herbs like garlic, other herbs that reduce blood lipids and atherosclerosis, such as chicory, and especially in india, homeopathy may help the entire symptom picture and constitution, although none of these will not take the place of drugs for serious cases). Also, there are also 2 types of high BP/"hypertension" that you should be aware of: (1) is "intrinsic" BP, which has no known cause, other than heredity, and can only be treated with drugs and activities such as relaxation, meditation, etc, and (2) is a "lifestyle" disease, and goes hand in hand with obesity, poor diet, high fats/meats/alcohol, diabetes, kidney disease, also "metabolic syndrome", etc, and should be appropriately treated with dietary and lifestyle modifications including much vegetables, low fat and low sugar diet, significant exercise, as well as relaxation, etc. The best treatment whenever possible is always prevention. Good luck in your learning.

Aggressive lowering of BP is recommended only in hypertensive crisis . This condition is manifested  by rapid rise of  BP with end organ damage , such as hypertensive encephalopathy , stroke , cardiac failure , acute kidney injury & acute coronary syndrome . Rapid rise of BP without end organ damage is considered as severe hypertension or hypertensive emergency , where lowering of BP need not be aggressive . It is definitely essential to lower the BP in every patient with hypertension to below 140/90 , but aggressive treatment is needed only in hypertensive crisis . I agree that lowering BP is essential in Diabetes & chronic kidney disease , but the choice of drugs are ACEI  &  ARBs to prevent progression of CKD . It is essential to remember that hypertension is a chronic disease , but can manifest as an acute disease during hypertensive crisis .

In the elderly hypertensive population I think lowering the SBP behind 140 mmHg, means aggressive therapeutic implication. Of course every treatment must be individualized, because not all the patients support these "low" values. In some patients the coronary or cerebral perfusion could be compromised. In think aggressive BP lowering is required only in hypertensive crisis, and after that antihypertensive treatment must be based on ABPM, including the calculation of BP variability, because its reduction could be at least so important that BP lowering.

http://www.eshonline.org/Guidelines/ArterialHypertension.aspx

The old standing order in surgical departments of giving sublingual nifedipine if BP > 160 mm Hg to quickly lower blood pressure has killed more patients than it possibly saved. 

Aggressive blood pressure lowering is rarely needed anymore , except in some cases of hypertensive emergencies. Even after a cerebrovascular accident, lowering blood pressure has become controversial. 

If you lower BP in clinical practice use long-acting drugs in order to obtain a stable and progressive decrease in BP. 

Aggressive lowering of BP is recommended only in hypertensive crisis . This condition is manifested by rapid rise of BP with end organ damage , such as hypertensive encephalopathy , stroke , cardiac failure , acute kidney injury & acute coronary syndrom.  It means to get the blood pressure into "safe" values as quickly as safely possible even these values aren't "normal". Typically with intravenous antihypertensive medications in a setting where they can be closely monitored.The "normal" values may be obtained in a few days.

Aggressive lowering of BP is not recommended except in malignant hypertension with end organ damage.

Hypertension (chronic or malignant)  is associated with auto-regulatory changes in cerebral blood flow. Rapid normalization of BP may lead to cerebral hypo-perfusion and brain injury. Therefore, the goal of treatment should not be normalization of BP in first few hours or days. BP should be lowered about 25%, maintaining DBP no less than 100 – 110 mm Hg.

"Aggressive" is an English adjective which sometimes connotes violence.  Therefore I do not think it has much (or any) place in medical terminology.  It may arise from American medical terminology, which has often borrowed from military parlance.  I encourage people to avoid this word in good medical practice, no matter how popular it is.

One reason this is important is that the term "aggressive lowering of BP" is often associated with "treatment to target" and/or treating to comply with guidelines which are often sponsored and/or influenced by the pharmaceutical industry.

Readers who wish to understand the known experimental evidence about treatment targets for routine high blood pressure (hypertension) can find a Cochrane Systematic Review of this topic by Prof. Jose Arguedas of the national university of Costa Rica.  The better guidelines, based upon real systematic review of evidence, usually cite this Cochrane Review (see www.cochrane.org).

The same review pointed out that there was no experimental evidence favouring lower systolic BP (SBP) targets in people with Type 2 diabetes or chronic kidney disease. 

The 2014 American JNC 8 guideline finally comes to terms with this evidence, revising its SBP targets upwards from where they had suggested previously.

For true malignant hypertension (hypertensive encephalopathy), and or for "hypertensive emergencies" or "hypertensive urgencies", to the best of my knowledge there is no known answer to the question of what is the best drug treatment.  Malignant hypertension is a completely different disease from routine rich country hypertension, since it involves rapid damage to brain, kidney, heart, retina, and potentially intravascular hemoloysis/DIC.  In that case, the real clinical question is what is the optimal treatment to avoid death and disability from these problems ... the BP is the surrogate measure.

If you are looking for an approach that differs from the conventional wisdom, consider focusing on treating the underlying cardiovascular (CV) disease.  Patients with the same BP have very different CV characteristics (see the first attached paper).  BP can be lowered in many ways.  In my opinion, it is important to identify the underlying CV abnormalities and then customize treatment to target the significant abnormalities.  Even in prehypertension, you could identify which patients should be treated (see the second attached paper).

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