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Improving outcomes for older hypertensive patients: is more intensive treatment better?

Yue Deng1, Yunlan Liu2, Li Yang3

  • 1Hypertension Center, FuWai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, Hebei, China.

Expert Review of Cardiovascular Therapy
|March 25, 2022
PubMed

Insights

Lowering systolic blood pressure (SBP) to below 130 mmHg in older adults with hypertension offers significant cardiovascular benefits and is safe. This intensive SBP target should be considered for broader guideline recommendations.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Hypertension Management

Background:

  • Late-life hypertension is a growing concern with aging populations.
  • Current guidelines may not reflect optimal systolic blood pressure (SBP) targets for older adults.
  • Evidence suggests additional cardiovascular benefits from more intensive SBP reduction.

Purpose of the Study:

  • To review the evolving understanding of late-life hypertension.
  • To discuss the optimal SBP target for older hypertensive patients.
  • To analyze recent evidence on intensive SBP treatment in this demographic.

Main Methods:

  • Review of antihypertensive drug-placebo studies.
  • Analysis of blood pressure target studies in older adults.
  • Inclusion of high-quality meta-analyses on intensive SBP treatment.

Main Results:

  • A systolic blood pressure (SBP) target of <130 mmHg is safe and beneficial for most older hypertensive patients.
  • Benefits are observed, though potentially to a lesser degree, in older patients with comorbidities like CKD or diabetes.
  • Intensive SBP targets require judicious application in specific extreme conditions.

Conclusions:

  • Robust evidence supports a <130 mmHg SBP target for older adults with hypertension.
  • Current relaxed SBP targets in guidelines need revision to <130 mmHg.
  • This intensive approach offers additional cardiovascular protection in the elderly.
Abstract

Keywords:
Blood pressurecardiovascular outcomehypertensionintensive treatmentolder patients

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