Blood pressure strategies and goals in elderly patients with hypertension

The growing number of elderly subjects with hypertension in western countries represents a demanding problem to find accurate blood pressure goals with an evidence base for such patients. Previously we did not have enough evidence, but more recently new evidence has accumulated based on data from the HYVET and the SPRINT studies. For most elderly hypertensives a blood pressure goal below 150/90 mm Hg still seems reasonable, even if a lower goal could be defended based on the recent SPRINT study outcomes. However, the debate on the methodologies for blood pressure measurement in SPRINT is still ongoing and this is why we have to wait until a new recommendation is available. It should not be forgotten that many elderly patients are frail and will therefore not tolerate blood pressure lowering similar to other more fit elderly subjects. This is why an individualised treatment strategy has to be developed for this age group, not to deny the fit elderly the benefits of appropriate blood pressure control, but at the same time avoiding harm and adverse effects in the frail elderly patient.