Abstract
Recommendations for the management of hypertension in the elderly are largely consistent with the exception of the 2013 Joint National Committee (JNC) 8 guidelines that recommend lowering systolic blood pressure (SBP) in persons aged ≥60 years to <150 mmHg if they do not have diabetes mellitus or chronic kidney disease. In contrast, I concur with the minority view from JNC 8 which recommends a SBP goal in these persons aged 60 to 79 years of <140 mmHg. This view is consistent with the 2011 American College of Cardiology/American Heart Association (ACC/AHA) guidelines that also recommend a SBP goal of 140 to 145 mmHg if tolerated in adults aged ≥80 years. ACC/AHA consensus guidelines use the totality of evidence in addition to randomized controlled trial data. These guidelines are also consistent with treatment recommendations from numerous other societies that recommend SBP goals of <140 mmHg in persons aged 60 to 79 years and <150 mmHg in persons aged ≥80 years. Hypertension is currently under-treated in the elderly, and relaxation of ACC/AHA guidelines by JNC 8 will result in substantially more cardiovascular events. Randomized clinical trial studies on treatment of essential hypertension or secondary hypertension in frail elderly persons have not been performed.
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