What is an acceptable blood pressure range for an older adult?

From the Guidelines

For older adults, an acceptable blood pressure range is generally considered to be below 130/80 mmHg, with a target systolic pressure between 130-139 mmHg and a diastolic pressure below 80 mmHg. This recommendation is based on the most recent and highest quality study, which suggests that targeting a systolic blood pressure of less than 150 mmHg can reduce the risk of mortality, stroke, and cardiac events in adults aged 60 years or older 1.

Key Considerations

• The American College of Physicians and the American Academy of Family Physicians recommend initiating treatment in adults aged 60 years or older with systolic blood pressure persistently at or above 150 mmHg to achieve a target systolic blood pressure of less than 150 mmHg 1.
• The 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases recommend a blood pressure goal of targeting systolic BP to 130 mmHg in patients with diabetes and <130 mmHg if tolerated, but not <120 mmHg, and a diastolic BP target of <80 mmHg, but not <70 mmHg 1.
• Lifestyle modifications, such as reducing sodium intake, regular physical activity, maintaining a healthy weight, limiting alcohol consumption, and following a heart-healthy diet, are also important for blood pressure management.

Medications and Lifestyle Modifications

• Common medications prescribed for blood pressure management include thiazide diuretics, ACE inhibitors, calcium channel blockers, or ARBs.
• Lifestyle modifications, such as reducing sodium intake to less than 2,300mg daily, regular physical activity like walking 30 minutes most days, maintaining a healthy weight, limiting alcohol consumption, and following a heart-healthy diet rich in fruits, vegetables, and whole grains, are also important.

Monitoring Blood Pressure

• Blood pressure naturally fluctuates throughout the day, so regular monitoring at home using a validated device is recommended, ideally at the same times each day while seated quietly with feet flat on the floor and arm supported at heart level.

From the Research

Acceptable Blood Pressure Range for Older Adults

The acceptable blood pressure range for older adults is a topic of ongoing debate and research. According to various studies, the following points can be noted:

• For adults aged 60-79 years, a blood pressure of less than 140/90 mmHg is recommended 2, 3.
• For adults aged 80 years and older, a blood pressure of less than 150/90 mmHg is recommended, with a target goal of less than 140/90 mmHg considered in those with diabetes mellitus or chronic kidney disease 2.
• The American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document on hypertension in the elderly recommends reducing blood pressure to less than 140/90 mmHg in adults aged 60-79 years and to 140-145 mmHg if tolerated in adults aged 80 years and older 2.
• Other guidelines, such as the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2013 guidelines and the 2013 Canadian Hypertension Education Program guidelines, also support reducing blood pressure to less than 140/90 mmHg in adults aged 60-79 years 2.

Considerations for Older Adults with Complex Health Conditions

For older adults with complex health conditions, such as frailty, multimorbidity, or polypharmacy, the management of hypertension may need to be adapted 4. The American College of Cardiology and the American Heart Association (ACC/AHA) 2017 guidelines for hypertension management lowered blood pressure thresholds to 130/80 mmHg, but the European Society of Cardiology and the European Society of Hypertension (ESC/ESH) 2018 guidelines retained 140/90 mmHg 4.

• A study found that about one out of two participants with elevated blood pressure and four out of five participants with uncontrolled blood pressure had a complex health condition 4.
• Another study found that the combinations of amlodipine plus valsartan and lisinopril plus hydrochlorothiazide were well tolerated and efficacious in adult patients with stage 2 hypertension, with both treatments achieving blood pressure goals in the majority of patients 5.

Ambulatory Blood Pressure in Elderly Men

A study of ambulatory and office blood pressure in a population of elderly men found that:

• The average 24-hour blood pressure in the population was 133 +/- 16/75 +/- 8 mmHg, and daytime blood pressure was 140 +/- 16/80 +/- 9 mmHg 6.
• An office recording of 140/90 mmHg corresponded to an ambulatory pressure of 130/78 (24 hours) and 137/83 mmHg (daytime) in untreated subjects 6.
• The prevalence of hypertension, defined as office blood pressure greater than or equal to 140/90 mmHg, was 66% 6.