What Should the Systolic Blood Pressure Treatment Goal Be in Patients Aged 60 Years and Older with Hypertension?

Abstract

While there is consensus that high blood pressure in older adults should be treated, there is significant variability among prominent therapeutic guidelines. This review will present seminal anti-hypertension trials establishing efficacy of BP-lowering therapy. Subanalyses focused on efficacy of antihypertensive therapy as part of management strategies for diverse CV diseases will also be provided. On the basis of these analyses, recommended guidelines will then be assessed. Guidelines from the recently published Eighth Joint National Committee (JNC 8) will be compared to the 2011 American College of Cardiology Foundation/American Heart Association, 2013 American Diabetes Society, 2012 International Society of Nephrology, and 2013 European Society of Hypertension/European Society of Cardiology guidelines for management of hypertension. Whereas most guidelines recommend treating systolic blood pressure in older adults to <140 mmHg, the JNC 8 recommendations are notably higher, targeting SBP of <150 mmHg for patients who do not have diabetes or CKD. To many experts, including this author, the higher target threshold seems imprudent, as increased risk for CV events likely outweighs any benefits.