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Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General

Heng-Yu Pan1, Po-Lung Yang2, Chun-Hsien Lin3

  • 1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan.

Journal of the Formosan Medical Association = Taiwan Yi Zhi
|September 25, 2024
PubMed

Insights

Managing blood pressure in older adults involves balancing heart benefits against risks. For those 65-80, aim for systolic pressure below 130 mmHg, with individualized targets for older or CKD patients.

Area of Science:

  • Gerontology
  • Cardiology
  • Nephrology

Background:

  • Optimal blood pressure (BP) targets for older adults present a challenge, requiring balancing cardiovascular advantages against risks of organ hypoperfusion.
  • Evidence indicates age and frailty minimally impact cardiovascular benefits of intensive BP control in community-dwelling elderly.
  • However, intensive BP control is linked to increased acute kidney injury in octogenarians.

Purpose of the Study:

  • To establish a consensus on optimal blood pressure targets for elderly individuals.
  • To evaluate the influence of age and frailty on the benefits and risks of intensive blood pressure control.
  • To provide guidance on antihypertensive medication selection and treatment strategies for elderly hypertensive patients.

Main Methods:

  • Review of existing evidence on blood pressure targets in the elderly.
  • Analysis of cardiovascular benefits versus risks of intensive blood pressure control.
  • Consideration of specific conditions like chronic kidney disease (CKD) and patient age groups.

Main Results:

  • A systolic BP target below 130 mmHg is recommended for hypertensive patients aged 65-80 years.
  • A systolic BP target below 120 mmHg may be suitable for CKD patients if tolerated.
  • No definitive BP target is established for individuals aged 80 and older.

Conclusions:

  • Hypertension management in the elderly necessitates a personalized strategy, weighing cardiovascular benefits against individual risks and tolerability.
  • Medication choices, including ACE inhibitors, ARBs, and mineralocorticoid receptor antagonists, should consider patient comorbidities like CKD.
  • Combination therapy may be required to achieve target blood pressure levels in this population.

Keywords:
AntihypertensiveBlood pressure targetChronic kidney diseaseDiabetesElderly

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