Hypertension and its Management in the Elderly

Many trials focused on cardiovascular outcomes demonstrate that reduction in blood pressure to levels below 140/90 mm Hg reduce cardiovascular events including stroke and myocardial infarction. There are very few such trials, however, in the elderly cohort, especially among those aged 70 and older. In the few outcome trials that have been completed in this older age group, systolic blood pressures in the range between 140 and 149 mm Hg demonstrate a clear reduction in cardiovascular events. Moreover, among the subgroup that has a vasculature that allows a systolic pressure to go below 140 mm Hg without cognitive side effects, ie, somnolence, memory loss, etc, does even better than those whose blood pressures are in the 140 to 149 mm Hg range. Thus, titration of systolic blood pressure goals in the elderly should strive for a goal of less than 140 mm Hg, and if not achievable without side effects, compromise to below 150 mm Hg.