[Blood pressure goal for hypertension in the elderly]

Blood pressure progressively increases with age and hypertension represents one of the most prevalent and potentially modifiable risk factors in older adults. Because of the high prevalence of multiple comorbidities and frailty, the management of hypertension in the elderly is more challenging than in younger patients. It is now soundly established from randomized clinical trials the benefit from treating hypertension in older hypertensive patients, including those over the age of 80 years. Although the prognostic benefit of active treatment is indisputable, it is still debated the ideal blood pressure target in the geriatric population. A critical review of trials analyzing the benefits of different blood pressure targets in elderly patients supports the notion that targeting a more intensive blood pressure goal may provide benefits which considerably outweigh the risks of unwanted effects (including hypotension, falls, acute kidney injury, and electrolyte disturbances). Furthermore, these prognostic benefits persist even in older patients who are frail. However, the optimal blood pressure control should achieve the maximum preventive benefits without causing harms or complications.In conclusion, age itself is not a barrier for treatment and it should not preclude a more intensive treatment of hypertension. Treatment should be personalized to achieve a more strict control of blood pressure (to prevent serious cardiovascular events), and to avoid over-treating frail older adults.