From the Guidelines
For an 82-year-old female, the target blood pressure should generally be below 150/90 mmHg, as recommended by the American College of Physicians and American Academy of Family Physicians 1. This recommendation is based on high-quality evidence that suggests treating to a lower blood pressure target does not further reduce mortality, quality of life, or functional status, but it does reduce the incidence of stroke and cardiac events. Some key points to consider when treating hypertension in this age group include:
- Starting with lifestyle modifications, such as reduced sodium intake, regular physical activity, and maintaining a healthy weight
- Using first-line medications like thiazide diuretics, calcium channel blockers, or ACE inhibitors/ARBs, but starting at lower doses and gradually increasing to avoid adverse effects
- Monitoring blood pressure regularly, including home measurements when possible
- Considering comorbidities, frailty status, and overall life expectancy when making treatment decisions
- Avoiding overly aggressive blood pressure lowering, which may increase the risk of falls, dizziness, and cognitive impairment in this age group. More recent guidelines from the European Society of Cardiology 1 also support a target blood pressure of less than 150/90 mmHg for adults aged 80 years or older, but suggest a more lenient target of less than 140/90 mmHg for individuals with symptomatic orthostatic hypotension or age 85 years or older. However, the American College of Physicians and American Academy of Family Physicians guideline 1 is more specific to the age group in question and provides a strong recommendation based on high-quality evidence.
From the Research
Target Blood Pressure for an 82-year-old Female
- The American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document recommends a systolic blood pressure of 140 to 145 mmHg if tolerated in adults aged 80 years and older 2.
- The European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2013 guidelines recommend a blood pressure below 150/90 mmHg in adults aged 80 years and older, with a target goal of less than 140/90 mmHg considered in those with diabetes mellitus or chronic kidney disease 2.
- A study published in Clinical Interventions in Aging in 2013 recommends a systolic blood pressure goal of 140-150 mmHg in patients 80 years of age or older 3.
- It is essential to consider the individual's overall health, comorbidities, and susceptibility to orthostatic hypotension when determining the target blood pressure 4, 5, 6.
- The treatment of hypertension in elderly patients should be individualized, taking into account the potential risks and benefits of antihypertensive therapy, as well as the presence of orthostatic hypotension 4, 5, 6.