Arterial hypertension: which targets in over-75-year people?

Area of Science:

• Gerontology
• Cardiology
• Clinical Medicine

Background:

• Arterial hypertension is a primary risk factor for cardiovascular disease.
• Optimal blood pressure targets for elderly hypertensive patients remain debated, with controversy surrounding the "lower the better" hypothesis versus the J-curve phenomenon.
• Cardiovascular event risk associated with blood pressure lowering in the elderly may be influenced by comorbidities, frailty, and disability.

Purpose of the Study:

• To evaluate the impact of intensive versus usual blood pressure targets in elderly hypertensive patients.
• To explore the role of cardio-geriatric functional assessment in stratifying risk and individualizing treatment targets for older adults with hypertension.

Main Methods:

• Review of recent studies, including the SPRINT trial, comparing intensive (SBP <120 mmHg) and usual (SBP <140 mmHg) blood pressure targets.
• Consideration of factors such as comorbidity, frailty, and disability in elderly hypertensive patients.
• Emphasis on cardio-geriatric functional assessment for patient stratification.

Main Results:

• Recent data suggest that an intensive blood pressure target (SBP <120 mmHg) may offer greater benefits in the oldest hypertensive patients (≥75 years).
• The association between blood pressure reduction and cardiovascular events in the elderly appears contingent on their overall health status.
• Cardio-geriatric functional assessment provides valuable data for risk stratification.

Conclusions:

• Intensive blood pressure targets may be beneficial for the oldest hypertensive individuals.
• Individualized blood pressure targets, informed by a comprehensive geriatric assessment, are essential for optimizing cardiovascular prevention in the elderly.
• Treatment decisions should account for patient-specific factors like comorbidity and functional status.