Threshold and Target for Blood Pressure Lowering in the Elderly
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Guido Grassi1,2, Fosca Quarti-Trevano3, Anna Casati3
1Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. guido.grassi@unimib.it.
Insights
Detecting high blood pressure in older adults is crucial for reducing cardiovascular risk. While the Systolic Blood Pressure Interventional Trial (SPRINT) suggests tight control, current guidelines recommend a more conservative approach for elderly patients.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Elevated blood pressure in the elderly is common and increases cardiovascular risk.
- Antihypertensive treatment benefits are established, but initiation thresholds and target goals remain debated.
- Both systodiastolic and isolated systolic hypertension in older adults require careful management.
Purpose of the Study:
- To critically review evidence on blood pressure thresholds and goals for antihypertensive drug treatment in the elderly.
- To analyze the impact of recent Systolic Blood Pressure Interventional Trial (SPRINT) findings on elderly hypertension management.
- To evaluate current guidelines and consensus statements regarding antihypertensive therapy in aged individuals.
Main Methods:
- Critical review of existing evidence on antihypertensive treatment in elderly patients.
- Analysis of data from the Systolic Blood Pressure Interventional Trial (SPRINT), including its applicability to the elderly population.
- Evaluation of current clinical guidelines and consensus statements.
Main Results:
- The SPRINT trial demonstrated benefits of intensive blood pressure reduction (systolic blood pressure ≤120 mmHg) in individuals over 75 years.
- However, the SPRINT trial has limitations that restrict its generalizability to all elderly hypertensive patients.
- Current guidelines suggest more conservative blood pressure targets for the general elderly hypertensive population.
Conclusions:
- While intensive blood pressure lowering shows promise, its application in the elderly requires careful consideration of trial limitations.
- A prudent clinical approach involves adopting less intensive, conservative blood pressure targets as recommended by current guidelines.
- Further research and ongoing clinical studies are needed to clarify optimal antihypertensive strategies for elderly patients.
Purpose Of Review:
Detection of elevated blood pressure values in elderly patients represents a common clinical condition associated with an increased cardiovascular risk. This has been shown to be the case in both systodiastolic and isolated systolic hypertension as well. However, despite the evidence of the benefits of the blood pressure lowering intervention in terms of reduction of cardiovascular morbidity and mortality, at least two issues related to antihypertensive drug treatment in aged individuals are still undefined: (1) the blood pressure threshold at which antihypertensive drug should be initiated and (2) the blood pressure goals of the therapeutic intervention.
Recent Findings:
The present paper will critically review the evidence available so far on these two issues as well as the position of current guidelines and consensus statements. Emphasis will be given to the analysis of the new data of the Systolic Blood Pressure Interventional Trial (SPRINT), which have recently demonstrated the benefits, even in individuals aged more than 75 years, of a tight blood pressure reduction to systolic blood pressure to 120 mmHg or less. The potential limitations of the trial will be also critically addressed and the expectations of ongoing clinical studies investigating the issue in elderly patients properly emphasized. Although of interest, the results of the SPRINT trial encompass a number of limitations which limit their applicability to the general elderly hypertensive population. A prudent approach will be to adopt in clinical practice the less intensive and more conservative targets recommended by current guidelines.
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Hypertension (High blood pressure)
Hypertension occurs when blood pressure readings consistently exceed the normal range. It is diagnosed when systolic blood pressure (the top number, indicating pressure while the heart...