From the Guidelines
For a 90-year-old with chronic kidney disease (CKD), it is recommended to lower systolic BP to a range of 130–139 mmHg, as stated in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. This approach is based on the latest guidelines, which emphasize individualized treatment according to its tolerability and impact on renal function and electrolytes.
- Key considerations in managing blood pressure for this patient population include:
- Starting with lifestyle advice and BP-lowering medication for office BP ≥140/90 mmHg 1
- Using RAS blockers, such as ACE inhibitors or ARBs, as part of the treatment strategy due to their effectiveness in reducing albuminuria 1
- Targeting systolic BP to 120–129 mmHg in adults with moderate-to-severe CKD who are receiving BP-lowering drugs and have eGFR >30 mL/min/1.73 m², if tolerated 1
- When selecting medications, it is essential to consider the potential benefits and risks, including the risk of orthostatic hypotension, falls, and medication side effects in elderly patients with CKD.
- Regular monitoring, including BP checks, kidney function tests, and electrolytes, is crucial to ensure the treatment strategy is effective and safe 1.
From the Research
Blood Pressure Targets for 90-Year-Old with CKD
- The ideal blood pressure target for a 90-year-old with chronic kidney disease (CKD) is a topic of discussion among medical professionals, with various guidelines and studies providing recommendations 2, 3, 4, 5, 6.
- According to the American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document, the recommended blood pressure target for adults aged 80 years and older is less than 140/90 mmHg, or 140 to 145 mmHg if tolerated 4.
- Studies have shown that a blood pressure target of less than 140/90 mmHg is reasonable for most patients with CKD, with more aggressive lowering not firmly supported by current data 2, 3, 6.
- However, for patients with CKD and proteinuria, a lower blood pressure target may be beneficial, with some studies suggesting a target systolic blood pressure of 120 to 130 mmHg and diastolic blood pressure of 70 to 80 mmHg 3, 6.
- It is essential to individualize hypertension therapy and monitor blood pressure regularly to avoid potential symptoms and adverse events from hypotension 2, 6.
Considerations for Elderly Patients with CKD
- Elderly patients with CKD require careful consideration of their blood pressure targets, taking into account their overall health, comorbidities, and potential risks and benefits of aggressive blood pressure lowering 4, 5.
- The 2013 Eighth Joint National Committee (JNC 8) guidelines recommend reducing blood pressure to less than 140/90 mmHg in adults aged 60 years and older with diabetes mellitus or CKD, but to less than 150/90 mmHg in those without these conditions 4.
- However, some experts disagree with this recommendation, citing concerns about increased cardiovascular events and mortality with higher systolic blood pressure goals in elderly patients without diabetes mellitus or CKD 4.