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What is an appropriate blood pressure goal for the elderly: review of recent studies and practical recommendations

Authors Denker MG, Cohen DL

Received 19 September 2013

Accepted for publication 11 October 2013

Published 14 November 2013 Volume 2013:8 Pages 1505—1517


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Matthew G Denker, Debbie L Cohen

Perelman School of Medicine, Renal, Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA

Abstract: Hypertension is common in the elderly, and isolated systolic hypertension is responsible for the majority of hypertension in this population. Hypertension in the elderly can be attributed to numerous structural and functional changes to the vasculature that develop with advancing age. Increased systolic blood pressure is associated with adverse outcomes, including stroke, cardiovascular disease, and death. Some studies demonstrate an inverse relationship between cardiovascular outcomes and diastolic blood pressure whereas other studies show a J-shaped or U-shaped association between blood pressure and outcomes. The complex J-shaped association coupled with the unique characteristics of elderly patients have led to much debate and confusion regarding the treatment of hypertension in this population. Clinical trials indicate a benefit to therapy in older adults, and there appears to be no age threshold above which antihypertensive therapy should be withheld. Treatment of hypertension in elderly patients is further complicated by increased susceptibility to brain hypoperfusion with orthostatic hypotension as well as the risk of drug–drug interactions. We recommend a systolic blood pressure goal of <140 mmHg in patients less than 80 years of age and a systolic blood pressure goal of 140–150 mmHg in patients 80 years of age or older. Reduction of blood pressure is probably more important than the specific agent used and initiation of drug therapy with an angiotensin converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or diuretic are all reasonable options, and the decision should be individualized based on underlying comorbidities.

Keywords: hypertension, blood pressure target, antihypertensive treatment, elderly

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