From the Guidelines
For a 91-year-old patient with normotension, a normal blood pressure range is generally considered to be below 150/90 mmHg, as recommended by the American College of Physicians and the American Academy of Family Physicians 1. This recommendation is based on high-quality evidence that shows treating hypertension in older adults to moderate targets (<150/90 mmHg) reduces mortality, stroke, and cardiac events.
Key Considerations
- The American College of Cardiology/American Heart Association guideline also suggests that for noninstitutionalized, ambulatory, community-dwelling adults aged 65 years or older with an average SBP of 130 mm Hg or higher, treatment of hypertension with an SBP goal of less than 130 mm Hg is recommended 1.
- However, for very elderly patients, a slightly higher reading of up to 150/90 mmHg may be allowed to avoid risks associated with overly aggressive blood pressure lowering.
- Blood pressure management in the elderly requires careful consideration, and overly strict control can lead to issues like dizziness, falls, or reduced blood flow to vital organs.
Lifestyle Measures
- Maintaining a healthy weight, limiting salt intake, regular exercise, and stress management are also important for blood pressure control at this age.
- Any changes to diet or exercise routines should be discussed with a healthcare provider first.
Goal of Treatment
- The goal is to balance cardiovascular protection with quality of life and overall well-being in elderly patients, recognizing that as people age, their bodies may handle blood pressure differently, and what's considered "normal" can shift slightly upward compared to younger adults.
- A systolic pressure between 120-140 mmHg and a diastolic pressure below 90 mmHg is often appropriate for this age group, but individual targets may vary based on overall health and other medical conditions.
From the Research
Normal Blood Pressure Range for a 91-year-old Patient
The normal blood pressure range for a 91-year-old patient with normotension can be determined based on various studies.
- According to 2, a normal blood pressure in elderly persons, including those 75 years of age and older, is diagnosed if the blood pressure is below 120/80 mmHg.
- However, 3 states that the French guideline recommends a target blood pressure of <140/90 mmHg, with <150 mmHg for patients aged >80 years.
- Additionally, 4 recommends a systolic blood pressure goal of 140-150 mmHg in patients 80 years of age or older.
- It is also worth noting that 5 recommends reducing systolic blood pressure to between 140 mmHg and 150 mmHg in fit individuals older than 80 years with an initial systolic blood pressure ≥160 mmHg.
Blood Pressure Targets
The blood pressure targets for a 91-year-old patient with normotension may vary depending on the specific guidelines and studies.
- 3 recommends a target blood pressure of ≤150/90 mmHg for patients aged >60 years.
- 4 recommends a systolic blood pressure goal of <140 mmHg in patients less than 80 years of age and a systolic blood pressure goal of 140-150 mmHg in patients 80 years of age or older.
- 2 recommends treating elderly patients with hypertension to a blood pressure goal of less than 130/80 mmHg if the blood pressure was obtained by automated blood pressure monitoring in a quiet room.
Considerations for Elderly Patients
When considering blood pressure targets for a 91-year-old patient with normotension, it is essential to take into account the patient's overall health and any comorbidities.
- 5 recommends basing treatment decisions on comorbidity and carefully monitoring the effects of treatment in frail elderly patients.
- 4 notes that treatment of hypertension in elderly patients is further complicated by increased susceptibility to brain hypoperfusion with orthostatic hypotension as well as the risk of drug-drug interactions.
- 2 suggests that the initial drug of choice for the treatment of hypertension in adults aged 75 years and older should be based on co-morbidities, co-incidental indications, tolerability, and cost.