Blood Pressure Goals and Targets in the Elderly

The American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document on hypertension in the elderly recommends that the blood pressure be reduced to less than 140/90 mmHg in adults aged 60-79 years and the systolic blood pressure to 140 to 145 mmHg if tolerated in adults aged 80 years and older. I strongly support these guidelines based on clinical trial data, especially from the Systolic Hypertension in the Elderly trial and from the Hypertension in the Very Elderly trial (HYVET). Other guidelines supporting reducing the blood pressure to less than 140/90 mmHg in adults aged 60 to 79 years of age include the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2013 guidelines, the minority report from the 2013 Eighth Joint National Committee (JNC 8) guidelines, the 2013 Canadian Hypertension Education Program guidelines, the 2011 UK guidelines, the 2014 American Society of Hypertension (ASH)/International Society of Hypertension (ISH) guidelines, and the 2015 AHA/ACC/ASH scientific statement on treatment of hypertension in patients with coronary artery disease. I support these guidelines. In adults aged 80 years and older, a blood pressure below 150/90 mm Hg has been recommended by these guidelines, with a target goal of less than 140/90 mmHg considered in those with diabetes mellitus or chronic kidney disease. I support these guidelines. The 2013 JNC 8 guidelines recommend reducing the blood pressure to less than 140/90 mmHg in adults aged 60 years and older with diabetes mellitus or chronic kidney disease but to less than 150/90 mmHg in adults aged 60 years and older without diabetes mellitus or chronic kidney disease. I strongly disagree with this recommendation and am very much concerned that the higher systolic blood pressure goal recommended by JNC 8 guidelines in adults aged 60 years and older without diabetes mellitus or chronic kidney disease will lead to an increase in cardiovascular events and mortality in these adults.