Blood Pressure Targets in the Hypertensive Elderly

OBJECTIVE: Hypertension is an important risk factor of cardiovascular disease and increases mortality in the elderly. However, the available medical evidences are both inconsistent and insufficient regarding establishing credible and useful blood pressure (BP) targets in the hypertensive elderly. This review summarizes the existing evidences used for establishing optimal BP targets for this patient population and points out some data inconsistencies which have added to the uncertainty. DATA SOURCES: We conducted a search for the articles published in English in the PubMed database up to March 2017, with the keywords “hypertension,” “elderly,” “blood pressure,” and “antihypertensive.” STUDY SELECTION: Articles that related to BP targeting in the hypertensive elderly were selected for this review. RESULTS: The selected studies indicated that antihypertensive therapy can substantially reduce the risk of cardiovascular events and mortality, for a subset of the elderly (60 years or older) with systolic BP >160 mmHg. Studies regarding more strict targets yielded mixed findings. For the very old and frail patients (80 years or older), there is a lack of evidence that optimal BP targets and intensive antihypertensives are helpful but in fact may be harmful. CONCLUSIONS: There are solid evidences that patients who are 60–80 years old and in good health have benefited from lowering their BP to below 150/90 mmHg. If well tolerated, the BP target can be further lowered to below 140/90 mmHg. However, for the very old and frail, individualized and careful assessment is crucial. Antihypertensive treatment should be cautious and the adverse effect of drugs requires close monitoring as such treatment can be counterproductive.