Hypertension Guidelines for Older Adults

The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have just published an evidence-based clinical practice guideline on the appropriate systolic pressure target specifically for adults aged 60 years and older (Ann Int Med. 2017; doi:10.7326/M16-1785).

ACP and AAFP recommend that physicians initiate treatment in adults aged 60 years and older with persistent systolic blood pressure at or above 150 mm Hg to achieve a target systolic blood pressure of less than 150 mm Hg to reduce the risk of mortality, stroke, and cardiac events.

The guideline is based on a systematic review of published randomized, controlled trials for primary outcomes and observational studies for harms only. The evidence review was conducted by the Portland VA Health Care System Evidence-based Synthesis Program.

“The evidence showed that any additional benefit from aggressive blood pressure control is small, with a lower magnitude of benefit and inconsistent results across outcomes,” said Nitin S Damle, MD, MS, MACP, president, ACP, in an AAFP press release. “Most benefits of targeting of less than 150 mm Hg apply to individuals regardless of whether or not they have diabetes.”

John Meigs Jr, MD, president, AAFP, said: “The most accurate measurements come from multiple blood pressure measurements made over time. These may include multiple measurements in clinical settings or ambulatory or home-monitoring.” 

The guideline also recommended “that physicians consider initiating or intensifying drug therapy in adults aged 60 years and older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk of recurrent stroke.” 

In addition, physicians should consider “initiating or intensifying pharmacological treatment in some adults aged 60 years old and older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk of stroke or cardiac events.”—Amanda Del Signore