Normal Blood Pressure for Older Adults
For older adults (≥65 years), normal blood pressure is considered less than 130/80 mmHg according to the 2017 American College of Cardiology/American Heart Association guidelines. 1
Blood Pressure Categories for Older Adults
- Normal BP: Less than 120/80 mmHg 1
- Elevated BP: 120-129/<80 mmHg 1
- Stage 1 hypertension: 130-139/80-89 mmHg 1
- Stage 2 hypertension: ≥140/90 mmHg 1
Special Considerations for Older Adults
- Isolated systolic hypertension is the predominant form of hypertension in older persons 1
- Randomized trials have demonstrated that more intensive BP-lowering therapy safely reduced risk for cardiovascular events for adults older than 65,75, and 80 years 1
- Blood pressure-lowering therapy is one of few interventions shown to reduce mortality risk in frail older adults 1
- For ambulatory, community-dwelling adults aged 65 years or older, treatment of hypertension with an SBP goal of less than 130 mmHg is recommended 1
Treatment Thresholds
- Clinicians can assume that adults aged 65 years or older with hypertension have a 10-year ASCVD risk of at least 10%, placing them in a high-risk category 1
- Drug therapy should be initiated at an SBP of 130 mmHg or higher in older adults 1
- For older adults with a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach should guide decisions about intensity of BP control 1
Monitoring Considerations
- Careful titration of BP-lowering medications and close monitoring are especially important in older adults with comorbidities 1
- Initiation of BP-lowering therapy, especially with 2 drugs, should be done with caution in older persons 1
- Monitor carefully for adverse effects, including orthostatic hypotension 1, 2
- Proper BP measurement technique is critical for accurate diagnosis and management 1
Evidence Evolution
- Earlier guidelines (pre-2017) recommended higher targets for older adults, with systolic BP goals of <150 mmHg for adults aged 80 years and older 3, 4
- The 2017 ACC/AHA guidelines lowered the target to <130 mmHg based on evidence from trials like SPRINT and HYVET 1
- Some recent research suggests that while lower targets reduce stroke and cardiovascular events, the effect on all-cause mortality remains unclear 5, 6
Common Pitfalls to Avoid
- Failing to use proper BP measurement technique, which can lead to inaccurate readings and inappropriate treatment decisions 1
- Ignoring orthostatic hypotension assessment, which is particularly important in older adults 2
- Initiating multiple medications simultaneously without careful monitoring 1
- Not considering individual risk factors, comorbidities, and life expectancy when determining appropriate BP goals 1
While some controversy exists regarding optimal BP targets in the very elderly (≥80 years), the current evidence supports treating to a target of <130/80 mmHg in most ambulatory older adults to reduce cardiovascular events and mortality 1, 7.