What are the recommended blood pressure targets and management approach for adults older than 80 years?

For adults older than 80 years, the blood‑pressure goal should be individualized but generally aim for a systolic pressure between 130 mm Hg and 150 mm Hg and a diastolic pressure below 80 mm Hg to 90 mm Hg, provided the patient tolerates it without symptoms of hypotension, dizziness, falls, or renal dysfunction. In relatively healthy, non‑frail octogenarians who can tolerate treatment, a tighter target of <130/80 mm Hg may be pursued; in frail or cognitively impaired individuals, a more conservative target of <150/90 mm Hg is safer. Begin antihypertensive therapy at low doses, titrate slowly, and monitor orthostatic blood pressures and renal function. First‑line medication options include a low‑dose thiazide‑type diuretic, an ACE‑inhibitor or ARB, or a long‑acting calcium‑channel blocker; choose agents based on comorbidities (e.g., avoid β‑blockers if severe COPD, avoid ACE‑inhibitors if hyper‑kalemia). If the initial drug does not achieve target, add a second agent from a different class, again using low starting doses. Non‑pharmacologic measures—reducing dietary sodium, encouraging a DASH‑type diet, moderate regular activity as tolerated, and maintaining adequate hydration—should accompany drug therapy. Regular follow‑up every 1–3 months is recommended to assess blood‑pressure control, side‑effects, and functional status, adjusting targets as the patient’s health status changes.