What is considered a normal blood pressure reading in elderly patients?

From the Guidelines

Normal blood pressure for elderly patients is generally considered to be below 130/80 mmHg, with a target systolic blood pressure of less than 130 mmHg, if tolerated, as recommended by the most recent guidelines 1.

Key Considerations

• The American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension guidelines recommend lower blood pressure treatment targets compared to previous guidelines 1.
• For older adults (≥65 years), the target is systolic blood pressure <130 mmHg, if tolerated, with a diastolic blood pressure target of <80 mmHg 1.
• Lifestyle modifications, such as reducing sodium intake, maintaining a healthy weight, regular physical activity, limiting alcohol consumption, and managing stress, remain important for blood pressure control 1.

Blood Pressure Monitoring

• Elderly patients should monitor their blood pressure regularly at home, ideally at the same time each day while seated with their back supported and feet flat on the floor after resting for 5 minutes 1.
• They should bring these readings to medical appointments to ensure accurate blood pressure measurement and adjustment of treatment as needed.

Treatment Approach

• The treatment approach should be individualized based on overall health status, with consideration of the benefits and harms of specific blood pressure targets 1.
• Clinicians should select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient 1.

From the Research

Normal Blood Pressure in Elderly Patients

• A normal blood pressure reading in elderly patients is generally considered to be below 120/80 mmHg 2.
• However, the optimal target blood pressure in elderly patients is still a topic of debate, with some studies suggesting that a systolic blood pressure (SBP) of less than 150 mmHg may be beneficial 3.
• The American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document recommends reducing blood pressure to less than 140/90 mmHg in adults aged 60-79 years and to 140-145 mmHg in adults aged 80 years and older 4.
• Other guidelines, such as the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2013 guidelines, also recommend reducing blood pressure to less than 140/90 mmHg in adults aged 60-79 years 4.
• In adults aged 80 years and older, a blood pressure below 150/90 mmHg has been recommended, with a target goal of less than 140/90 mmHg considered in those with diabetes mellitus or chronic kidney disease 4.

Blood Pressure Goals in Elderly Patients

• The goal of blood pressure treatment in elderly patients should be individualized, taking into account the patient's underlying comorbidities and the risk of adverse events 3, 5.
• A systolic blood pressure goal of less than 140 mmHg is recommended in patients less than 80 years of age, while a goal of 140-150 mmHg is recommended in patients 80 years of age or older 5.
• The choice of antihypertensive medication should be based on the patient's comorbidities, coincidental indications, tolerability, and cost 2.
• Reduction of blood pressure is probably more important than the specific agent used, and initiation of drug therapy with an angiotensin converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or diuretic are all reasonable options 5.