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Hypertension in the Oldest Old

Mark A Supiano1, Simon B Ascher2, Michael W Rich3

  • 1Spencer Fox Eccles School of Medicine and University of Utah Center on Aging, Salt Lake City, Utah, USA.

JACC. Advances
|November 13, 2025
PubMed

Insights

Hypertension is common in adults aged 80 and older, increasing risks for serious health issues. This review proposes the geriatrics 4 Ms model for individualized hypertension management in the oldest adults.

Area of Science:

  • Geriatric Medicine
  • Cardiovascular Research
  • Public Health

Background:

  • Hypertension is highly prevalent in adults aged 80+, significantly contributing to cardiovascular disease, stroke, kidney disease, and cognitive impairment.
  • Antihypertensive therapy offers benefits for major cardiovascular events and cognitive decline in this demographic.
  • Clinical trials have historically excluded many oldest old patients due to frailty, cognitive issues, comorbidities, or nursing home residency.

Purpose of the Study:

  • To review the epidemiology, pathophysiology, diagnosis, and management of hypertension in adults aged 80 years and older.
  • To introduce the geriatrics 4 Ms model as a patient-centered care framework for this population.
  • To highlight the need for further research in underrepresented groups and the role of deprescribing.

Main Methods:

  • Literature review of hypertension in the oldest old (≥80 years).
  • Analysis of epidemiological data and pathophysiology.
  • Discussion of diagnostic and management strategies, including the proposed 4 Ms model.

Main Results:

  • Hypertension is a critical risk factor for morbidity and mortality in the oldest old.
  • Existing evidence supports antihypertensive therapy but highlights exclusion of vulnerable subgroups from trials.
  • The geriatrics 4 Ms model offers a structured approach to individualized care.

Conclusions:

  • Individualized, patient-centered care is essential for managing hypertension in the oldest old.
  • The geriatrics 4 Ms model provides a framework for addressing the complexities of hypertension in this population.
  • Further research is crucial, particularly focusing on underrepresented patients and deprescribing strategies.

Keywords:
deprescribinggeriatrics 4 Ms modelhypertensionoldest old

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