Should target blood pressure in the elderly be the same as in younger?
Treatment of elevated blood pressure in the elderly including those older than 80 years of age is clearly beneficial.
Current studies indicate that intensive blood pressure lowering (systolic <120 mm Hg) can decrease both cardiovascular outcomes and mortality in nondiabetics including those 75 years or older. Intensive BP lowering in patients ≥50 years of age does not significantly impact chronic kidney disease progression; however, intensive BP lowering may increase risk for acute kidney injury events and incidence of hypotension in the elderly. While recommended BP goal is SBP <140 mm Hg for the general population and more intensive control of SBP <120 mm Hg considered for nondiabetics with increased cardiovascular risk, no clear data provide guidance related to the minimum diastolic BP that can be tolerated when treating elderly patients with isolated systolic hypertension (ISH). An analysis from the Systolic Hypertension in the Elderly Program (SHEP) trial found significant increases in cardiovascular events in the active treatment group when the diastolic BP was ≤60 mm Hg. Among patients being treated for ISH, the post-treatment diastolic blood pressure should be >60 mm Hg overall or, in patients with known coronary artery disease, >65 mm Hg unless symptoms attributable to hypo-perfusion occur at higher pressures. SBP goals should not be reached at the expense of excessive DBP reduction.