What are the ideal blood pressure targets for individuals older than 80 years?

From the Guidelines

For individuals older than 80 years, the ideal blood pressure target is generally below 140/90 mmHg, with a more lenient target of below 150/90 mmHg considered for those with symptomatic orthostatic hypotension or age ≥85 y 1.

Key Considerations

• Treatment should be initiated gradually with lower medication doses to avoid adverse effects like orthostatic hypotension, falls, and electrolyte imbalances.
• First-line medications typically include thiazide diuretics (such as chlorthalidone 12.5-25 mg daily or hydrochlorothiazide 12.5-25 mg daily), calcium channel blockers (amlodipine 2.5-10 mg daily), or ACE inhibitors (lisinopril 2.5-10 mg daily) 1.
• Blood pressure should be monitored both sitting and standing to detect orthostatic drops.
• Treatment goals should be individualized based on frailty, comorbidities, and medication tolerance.

Rationale

The rationale for these targets in the elderly is that aging blood vessels have reduced elasticity, and older adults often have impaired autoregulation of blood flow to vital organs, making them more susceptible to hypoperfusion if blood pressure is lowered too aggressively 1.

Monitoring and Adjustment

Regular monitoring and gradual adjustment of medications are essential to achieve optimal control while minimizing side effects.

Evidence-Based Recommendations

The 2024 European Society of Cardiology guidelines recommend a systolic blood pressure target of 120–129 mmHg in all adults if tolerated, with a more lenient target of <140/90 mmHg considered for individuals with symptomatic orthostatic hypotension or age ≥85 y 1.

From the Research

Blood Pressure Goals for Individuals Older Than 80 Years

The ideal blood pressure targets for individuals older than 80 years are a topic of ongoing debate. According to various studies, the recommended blood pressure goals for this age group are:

• Less than 150/90 mmHg, with a target goal of less than 140/90 mmHg considered in those with diabetes mellitus or chronic kidney disease 2
• A systolic blood pressure goal of 140-150 mmHg in patients 80 years of age or older 3
• Lowering blood pressure to <140-150/90 mmHg in elderly patients with diabetes, providing the patient is in good condition 4

Considerations for Blood Pressure Management

When managing blood pressure in individuals older than 80 years, it is essential to consider the following factors:

• The presence of comorbidities, such as diabetes mellitus or chronic kidney disease, which may require more aggressive blood pressure control 2, 4
• The risk of orthostatic hypotension, which may be increased in elderly patients with hypertension 3, 4
• The potential benefits and risks of lowering blood pressure, including the risk of stroke, cardiovascular disease, and death 2, 3, 5

Blood Pressure Targets in Specific Populations

In certain populations, such as those with coronary artery disease or orthostatic hypotension, excessive blood pressure lowering should be avoided 4. Additionally, in patients with isolated systolic hypertension, the same target blood pressure is reasonable, providing the diastolic blood pressure is >60 mmHg 4.