Goal Blood Pressure for Individuals Over 60 Years
For most adults over 60 years, target a blood pressure of <130/80 mmHg, with consideration for <140/90 mmHg as an acceptable alternative in those who cannot tolerate lower targets. 1, 2
Current Guideline Recommendations
The most recent authoritative guidelines from the American College of Cardiology/American Heart Association (2025) recommend a blood pressure target of <130/80 mmHg for adults with hypertension, including those aged 65 years and older. 1, 2 This represents the highest quality, most recent guidance available and should be the primary target for most patients over 60.
Alternative Targets Based on Patient Characteristics
Standard approach for age ≥60 years: The American College of Physicians and American Academy of Family Physicians recommend initiating treatment at systolic BP ≥150 mmHg with a target of <150 mmHg (strong recommendation, high-quality evidence). 3 However, this more conservative target has been superseded by newer evidence supporting lower targets.
High cardiovascular risk patients: Consider a target of <140/90 mmHg or lower (<130/80 mmHg) for patients with history of stroke/TIA, diabetes, chronic kidney disease, or other high cardiovascular risk factors. 1, 3, 2
Patients unable to tolerate aggressive targets: The European Society of Cardiology recommends a systolic BP target range of 130-139 mmHg for those aged 65 and older who cannot achieve lower targets without adverse effects. 2
Diastolic Blood Pressure Considerations
Maintain diastolic BP in the range of 70-79 mmHg as the optimal target. 3, 2 Avoid lowering diastolic BP below 60 mmHg, particularly in patients with isolated systolic hypertension or coronary artery disease. 4
Evidence Supporting Lower Targets
The recommendation for <130/80 mmHg is based on:
Meta-analyses demonstrating that age is not an effect modifier for treatment efficacy up to 85 years, supporting similar targets across age groups rather than relaxed targets for older adults. 1, 2
Clinical trials showing cardiovascular benefits with more intensive blood pressure control in older adults, including reductions in stroke, cardiac events, and mortality. 3, 2
The 2022 harmonization document between American and European guidelines confirming the benefit of targeting SBP <130 mmHg in adults with hypertension. 2
Controversy and Divergent Evidence
There is notable controversy in this area. The 2014 JNC-8 panel recommended a higher target of <150/90 mmHg for adults ≥60 years based on strict evidence-based criteria. 5, 6 However, this recommendation was strongly opposed by multiple professional societies, including the Association of Black Cardiologists, who argued that a 150 mmHg target was too high and potentially detrimental, particularly for high-risk populations. 5
The weight of current evidence and expert consensus has shifted toward lower targets (<130/80 mmHg), as reflected in the most recent ACC/AHA and ESC guidelines. 1, 2
Monitoring and Follow-Up
Initial follow-up within 2 months after initiating or adjusting treatment to assess efficacy and tolerability. 1, 3, 2
Once target BP is achieved, monitor every 3-6 months. 1, 3, 2
Measure BP in both sitting and standing positions to assess for orthostatic hypotension, particularly in patients ≥80 years. 3, 4
Common Pitfalls and Caveats
Avoid excessive BP lowering in patients with coronary artery disease or orthostatic hypotension, as this may worsen outcomes. 4
Monitor for treatment-related adverse events including cough, hypotension, syncope, electrolyte disturbances, and acute kidney injury. 3
Do not use a one-size-fits-all approach—individualize targets based on comorbidities, frailty, and tolerability while still aiming for the lower targets when feasible. 2, 4
Confirm persistently elevated BP before initiating treatment and consider ambulatory BP monitoring to rule out white coat hypertension. 3
Good news: Treatment does not increase risk of falls, fractures, or cognitive decline in older adults, contrary to common concerns. 3