Blood Pressure Target for Elderly Male with Newly Diagnosed Hypertension According to JNC8
The correct answer is D - less than 150 mmHg systolic for elderly patients (typically defined as ≥60 years old) according to JNC8 guidelines.
JNC8 Blood Pressure Targets by Age
The JNC8 guideline established age-specific blood pressure targets that differ from other contemporary guidelines:
- For adults ≥60 years old without diabetes or chronic kidney disease: Target BP <150/90 mmHg 1
- For adults <60 years old: Target BP <140/90 mmHg 1
- For adults ≥60 years old WITH diabetes or chronic kidney disease: Target BP <140/90 mmHg 1
Important Context About JNC8 Recommendations
The JNC8 recommendation for <150/90 mmHg in elderly patients without diabetes or CKD has been controversial and is NOT supported by most other major guidelines 2. This higher target was based on limited evidence and has been criticized by many experts who strongly disagree with this recommendation due to concerns it will lead to increased cardiovascular events and mortality 2.
Current Guideline Consensus (Post-JNC8)
Most contemporary guidelines recommend MORE aggressive targets than JNC8:
- ACC/AHA 2011 guidelines recommend <140/90 mmHg for adults aged 60-79 years 2
- For adults ≥80 years: Target systolic BP 140-145 mmHg if tolerated, with a minimum of <150/90 mmHg 3, 2
- European Society of Hypertension/Cardiology 2013 guidelines support <140/90 mmHg for ages 60-79 2
- Multiple guideline societies (ESH/ESC, Canadian, UK, ASH/ISH) all recommend <140/90 mmHg rather than the JNC8 target 2, 4
Clinical Application for Real Practice
While JNC8 technically says <150/90 mmHg for elderly patients, you should aim for <140/90 mmHg in relatively healthy elderly patients (60-79 years) based on stronger evidence from trials like SHEP and HYVET 2, 4:
- For patients 60-79 years in good health: Target <140/90 mmHg 3, 5
- For patients ≥80 years or frail elderly: Individualize based on tolerability, minimum target <150/90 mmHg 3, 5
- If well-tolerated and high cardiovascular risk: Consider <130/80 mmHg 3, 6
Critical Pitfall to Avoid
Do not use chronological age alone to determine BP targets - base treatment decisions on functional status and frailty, not age 3. The JNC8 recommendation of <150/90 mmHg should be viewed as a minimum acceptable target, not an optimal goal for most elderly patients 2, 4.