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Impact of Elevated Blood Pressure on Cardiovascular and Cerebrovascular Outcomes in Older Adults: A

Jigar Patel1, Ronaldo Pichardo-Gonzalez1, Samantha Camp2

  • 1Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA.

Journal of Clinical Medicine
|July 28, 2026
PubMed

Insights

Older adults with moderately elevated blood pressure (140-159/90-99 mmHg) had lower risks of major adverse cardiovascular events than those with severely elevated pressure (≥160/100 mmHg). However, the survival benefit was small, suggesting individualized hypertension management is crucial.

Area of Science:

  • Cardiology
  • Geriatrics
  • Public Health

Background:

  • Hypertension (HTN) management is critical for reducing cardiovascular and cerebrovascular events in older adults.
  • Optimal blood pressure (BP) targets for managing HTN in the elderly remain uncertain.
  • This study compares adverse event rates in older adults with different levels of elevated BP presenting to the emergency department (ED).

Purpose of the Study:

  • To compare the incidence of major adverse cardiovascular events (MACE) between older adults with moderately elevated BP (SBP 140-159 mmHg, DBP 90-99 mmHg) and severely elevated BP (SBP ≥160 mmHg, DBP ≥100 mmHg) presenting to the ED.
  • To evaluate the association between different BP thresholds and outcomes such as all-cause mortality, acute kidney injury (AKI), congestive heart failure (CHF), acute myocardial infarction (AMI), ischemic stroke, and hemorrhagic stroke.

Main Methods:

  • Retrospective analysis of data from the Global Collaborative Network.
  • Inclusion of adults aged ≥65 years with essential HTN, excluding those with end-stage renal disease.
  • Comparison of two cohorts: Cohort 1 (SBP ≥160 mmHg, DBP ≥100 mmHg) and Cohort 2 (SBP 140-159 mmHg, DBP 90-99 mmHg).
  • Propensity score matching was utilized to balance baseline characteristics between the cohorts.
  • Primary outcome: all-cause mortality over 5 years. Secondary outcomes: AKI, CHF, AMI, ischemic stroke, and hemorrhagic stroke.

Main Results:

  • After propensity score matching, 191,829 patients were included in each cohort.
  • Cohort 2 (moderately elevated BP) demonstrated significantly lower risks for all primary and secondary outcomes compared to Cohort 1 (severely elevated BP).
  • The largest risk differences were observed for AKI (1.28%) and ischemic stroke (1.25%).
  • Absolute risk differences for all outcomes were uniformly small (<1%), including all-cause mortality (0.33%).

Conclusions:

  • While a moderately elevated BP target (140-159/90-99 mmHg) showed a statistically significant reduction in adverse outcomes compared to severely elevated BP (≥160/100 mmHg), the absolute survival benefit was minimal.
  • The small gains must be carefully weighed against potential risks of overtreatment, including medication costs, hypotension, and falls.
  • These findings emphasize the need for individualized, risk-based hypertension management strategies in older adults.

Keywords:
emergency departmenthypertensionmortalityolder adultssystolic blood pressure

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