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Management of hypertension in the elderly population

Raymond V Oliva1, George L Bakris

  • 1FASN, FASH, The University of Chicago Medicine, 5841 S. Maryland, MC 1027 Rm P-328, Chicago, Illinois 60637, USA.

The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
|August 24, 2012
PubMed

Insights

Hypertension management in older adults is crucial. The consensus recommends a blood pressure goal of less than 140/90 mmHg for the elderly, with diuretics and calcium antagonists as effective treatments.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Nephrology

Background:

  • Hypertension is prevalent in individuals aged 65 and older, with higher rates in African Americans and women.
  • Hypertension control is poorer in those aged 70+ compared to 60-69 year olds.
  • Limited trials in the elderly population restrict strong recommendations for goal blood pressure (BP).

Purpose of the Study:

  • To review the consensus report on hypertension management in the elderly.
  • To examine studies on goal BP and nephropathy progression in older adults.
  • To provide evidence-based recommendations for hypertension control in this demographic.

Main Methods:

  • Review of the American College of Cardiology/American Heart Association consensus report.
  • Analysis of specific studies focusing on goal BP and kidney disease in the elderly.
  • Synthesis of evidence to support BP targets and treatment strategies.

Main Results:

  • General evidence supports a BP goal of <150/80 mmHg for the elderly.
  • Consensus recommends <140/90 mmHg, or <140-145 mmHg if tolerated.
  • Data for those over 80 are limited, but <150/80 mmHg is suggested.

Conclusions:

  • Diuretics and calcium antagonists are effective single agents for hypertension treatment in the elderly.
  • Most elderly patients require multiple medications to achieve BP goals.
  • Further research is needed for optimal BP targets in the very elderly (over 80).

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