Appropriate blood pressure for the “old-old” (85 years and older)
Albert J Finestone
Temple University, School of Medicine, Philadelphia, PA, USA
Treating hypertension in patients over the age of 85 years, ie, the “old-old”, presents a challenge that is different from that encountered when treating any other age group. In 2010, individuals aged over 85 years were estimated to comprise 1.85% of the US population, with an estimate of 2.03% projected for 2025.1 Clearly, this is a small percentage, but not an insignificant number. When treating hypertension in patients over the age of 85 years, the usual target blood pressure is 150/80 mmHg for reduction of the risk of stroke, heart attack, and other cardiovascular events.2 In medical practice today, blood pressure is measured by a nurse or health worker using an automated blood pressure device, but not after a short rest, sitting or standing (as recommended to measure orthostatic hypotension, particularly if the patient is on treatment with antihypertensive medications). I will continue to emphasize orthostatic hypotension, since during sleep, the elderly – either under medication treatment, or not – frequently get out of bed during the night to urinate, which is associated with the usual drop in blood pressure during sleep.
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