What is the target blood pressure for a 92-year-old female?

From the Guidelines

For a 92-year-old female, the target blood pressure should generally be below 150/90 mmHg, with a reasonable goal of around 140-150/70-90 mmHg, as recommended by the most recent guidelines 1. This target acknowledges the physiological changes that occur with advanced age, such as stiffer blood vessels, which may not tolerate very low blood pressures, leading to potential complications like dizziness, falls, or inadequate organ perfusion.

Key Considerations

• Treatment should be initiated gradually with lower medication doses to avoid side effects, considering the individual's overall health status, frailty, cognitive function, and existing medical conditions 1.
• First-line medications might include a low-dose calcium channel blocker like amlodipine 2.5 mg daily or a low-dose ACE inhibitor such as lisinopril 2.5-5 mg daily, as suggested by recent guidelines 1.
• Blood pressure should be monitored regularly, including checking for orthostatic hypotension by measuring blood pressure while sitting and standing, to ensure the treatment approach is effective and safe.

Treatment Approach

• The goal is to reduce the risk of cardiovascular events while maintaining quality of life and avoiding medication-related adverse effects that are more common in the elderly 1.
• Nonpharmacologic options, such as lifestyle modifications, including weight loss, dietary changes like the DASH diet, and increased physical activity, should be considered as the first line of treatment or used concurrently with drug therapy for most patients with hypertension 1.
• The treatment approach should be individualized, taking into account the patient's specific needs and health status, and should be guided by the most recent and highest-quality evidence available 1.

From the Research

Target Blood Pressure for a 92-Year-Old Female

• The target blood pressure for adults aged 65 years and older is a systolic blood pressure (SBP) of less than 130 mm Hg 2.
• For adults aged 80 years and older, a blood pressure below 150/90 mm Hg has been recommended, with a target goal of less than 140/90 mm Hg considered in those with diabetes mellitus or chronic kidney disease 3.
• The American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document on hypertension in the elderly recommends that the blood pressure be reduced to less than 140/90 mm Hg in adults aged 60-79 years and the systolic blood pressure to 140 to 145 mm Hg if tolerated in adults aged 80 years and older 3.
• Lifestyle modifications, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption, are recommended as first-line therapy for hypertension 2, 4, 5.
• Increasing physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, and is a critical component of first-line treatment for elevated blood pressure or cholesterol 4.

Considerations for Older Adults

• For older adults, the decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 2.
• Randomized clinical trials have established the efficacy of blood pressure lowering to reduce the risk of cardiovascular disease morbidity and mortality 2.
• An SBP reduction of 10 mm Hg decreases the risk of cardiovascular disease events by approximately 20% to 30% 2.