Systolic Blood Pressure Goals to Reduce Cardiovascular Disease Among Older Adults

The 2014 Evidence-Based Guideline for the Management of High Blood pressure in Adults Report From the panel Members Appointed to the Eighth Joint National Committee (JNC 8) was recently published. This guideline recommended that older adults (≥ 60 years) without diabetes or chronic kidney disease with systolic blood pressure (SBP) ≥ 150 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg be initiated on antihypertensive medication with a treatment goal SBp/DBP < 150/90 mm Hg. In contrast, the previous 3 JNC guidelines recommended treatment for these individuals be initiated at SBP/DBP ≥ 140/90 mm Hg with goal SBP/DBP < 140/90 mm Hg. In this article, we review randomized trials of antihypertensive medication and observational data on SBP and DBP with cardiovascular outcomes among older adults, possible explanations underlying the different findings from these randomized trials and observational studies, and contemporary antihypertensive treatment patterns among older U.S. adults. In closing, we highlight future research needs related to hypertension and outcomes among older adults.