What is the target blood pressure and treatment approach for a healthy 74-year-old with hypertension?

From the Guidelines

For a healthy 74-year-old with hypertension, the target blood pressure should be less than 130/80 mmHg, as recommended by recent guidelines 1.

Treatment Approach

The treatment approach for a healthy 74-year-old with hypertension should begin with lifestyle modifications, including:

• A low-sodium diet
• Regular physical activity
• Weight management
• Limited alcohol consumption
• Smoking cessation if applicable If these measures are insufficient, medication therapy should be initiated, with first-line medications typically including:
• Thiazide diuretics (like chlorthalidone 12.5-25 mg daily or hydrochlorothiazide 12.5-25 mg daily)
• Calcium channel blockers (such as amlodipine 5-10 mg daily)
• ACE inhibitors/ARBs (like lisinopril 10-40 mg daily or losartan 25-100 mg daily) Treatment should start with a low dose and be titrated gradually to minimize side effects, which is particularly important in older adults, as noted in the 2017 American College of Cardiology/American Heart Association hypertension guideline 1.

Monitoring and Follow-up

Regular monitoring of blood pressure, kidney function, and electrolytes is essential, with follow-up visits every 2-4 weeks until the target is reached, then every 3-6 months thereafter, to balance cardiovascular risk reduction with the need to avoid adverse effects like orthostatic hypotension, which can increase fall risk in older adults, as highlighted in the European Heart Journal guidelines 1.

Goal of Treatment

The goal of treatment is to achieve blood pressure control while maintaining quality of life and functional independence, which is critical for older adults, as emphasized in the guidelines 1.

From the Research

Blood Pressure Goals for a Healthy 74-Year-Old

According to the provided evidence, the target blood pressure for a healthy 74-year-old with hypertension is:

• Systolic blood pressure (SBP) < 130 mm Hg 2
• Diastolic blood pressure (DBP) < 80 mm Hg 2

Treatment Approach

The treatment approach for a healthy 74-year-old with hypertension includes:

• Lifestyle modification, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption 2
• First-line drug therapy, which consists of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 2
• Titration of medication according to office and home SBP/DBP levels to achieve the target blood pressure 2

Considerations for Elderly Patients

For elderly patients, such as a 74-year-old, it is recommended to:

• Reduce blood pressure to < 140/90 mm Hg 3, 4
• Consider a systolic blood pressure goal of < 140 mm Hg 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 4
• Initiate treatment with lower doses of antihypertensive agents and bring the pressure down more slowly, monitoring for orthostatic hypotension, impaired cognition, and electrolyte abnormalities 5