Is 60 the New 80 in Hypertension?

Area of Science:

• Cardiology
• Geriatrics
• Public Health

Background:

• The 2014 Joint National Committee 8 (JNC 8) guideline recommended a systolic blood pressure target of <150 mmHg for adults aged 60 years and older.
• This recommendation contrasted with previous guidelines and has generated significant debate regarding optimal hypertension management in the elderly.

Purpose of the Study:

• To evaluate the implications of the JNC 8 guideline's relaxed blood pressure target for adults over 60.
• To discuss the evidence for and against liberalizing systolic blood pressure goals in older adults, considering recent trial data and population health trends.

Main Methods:

• Review of the JNC 8 guideline and subsequent publications.
• Analysis of data regarding hypertension control rates based on different systolic blood pressure thresholds (<140 mmHg vs. <150 mmHg).
• Consideration of emerging randomized trial evidence in older adult populations.

Main Results:

• Millions of adults over 60 would be classified as having controlled blood pressure under the <150 mmHg threshold, but not under the <140 mmHg target.
• Emerging evidence from randomized trials indicates potential benefits of targeting systolic blood pressure well below 140 mmHg in older adults.

Conclusions:

• Despite the JNC 8 recommendation, liberalizing the systolic blood pressure treatment target to <150 mmHg for adults under 80 years of age is not advisable.
• Maintaining a lower blood pressure target, supported by recent trial data, is crucial for preserving health and vitality in older adults, considering declining cardiovascular and cerebrovascular mortality.