From the Guidelines
For patients 65 years and above with hypertension, the blood pressure goal should be to achieve a target systolic blood pressure of less than 150 mm Hg to reduce the risk for mortality, stroke, and cardiac events. This recommendation is based on high-quality evidence from the American College of Physicians and the American Academy of Family Physicians, which suggests that treating hypertension in older adults to moderate targets (<150/90 mm Hg) reduces mortality, stroke, and cardiac events 1.
Key Considerations
- The benefits of treating hypertension in older adults apply regardless of whether they have diabetes, with the most consistent and greatest absolute benefit shown in trials with a higher mean systolic blood pressure at baseline (>160 mm Hg) 1.
- Nonpharmacologic treatment strategies, such as lifestyle modifications (weight loss, dietary changes like the DASH diet, and increased physical activity), are available and typically associated with fewer side effects than pharmacologic therapies 1.
- Effective pharmacologic options include antihypertensive medications, such as thiazide-type diuretics, ACE inhibitors, ARBs, calcium-channel blockers, and β-blockers, each with their own potential adverse effects 1.
Clinical Implications
- Clinicians should ensure accurate measurement of blood pressure before beginning or changing treatment of hypertension, using methods such as multiple measurements in clinical settings or ambulatory or home monitoring 1.
- Treatment goals should be individualized based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient, taking into account their age, comorbidities, and other factors 1.
From the Research
Blood Pressure Goals for Patients 65 Years and Above with Hypertension
- The blood pressure goal for patients 65 years and above with hypertension is less than 150/90 mmHg, as stated in the 2013 JNC 8 guidelines 2.
- However, some guidelines recommend a more stringent goal of less than 140/90 mmHg for adults aged 60-79 years, and a systolic blood pressure of 140-145 mmHg if tolerated in adults aged 80 years and older 2.
- The American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document on hypertension in the elderly also recommends reducing blood pressure to less than 140/90 mmHg in adults aged 60-79 years 2.
- A study published in 2022 recommends an SBP target of less than 130 mmHg in adults ≥65 years 3.
- It is essential to note that the optimal blood pressure goal may vary depending on the individual patient's risk factors, such as diabetes mellitus or chronic kidney disease 2, 4.
Considerations for Blood Pressure Management
- Lifestyle modifications, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption, are recommended as first-line therapy for hypertension 3.
- First-line drug therapy for hypertension consists of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 3.
- The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk 3.