A 2019 Systematic Review and Meta-Analysis of 19 randomised trials, incorporating more than 40,000 patients, performed by a team out of the Mayo Clinic looked at the utility of treating hypertension in people over 65 years of age¹.
Benefit was shown for the following groups:
> 65 Years Old
- all-cause mortality: RR 0.88 (95% CI: 0.81 – 0.94, follow-up 31 months)
- cardiovascular mortality
- myocardial infarction
- heart failure
- stroke
- chronic kidney disease
75 years or older
- all-cause mortality
- cardiovascular mortality
- stroke
- heart failure
- chronic kidney disease (if diabetic)
Stricter systolic BP targets (120 – 130 mm Hg) appear more appropriate when managing the risk of cardiovascular mortality. But if the aim is stroke prevention, then a more liberal (systolic) BP target (150 – 160 mm Hg) is appropriate. In trying to reduce the risk of heart-failure, any blood pressure reduction is significant and whether the approach is liberal or aggressive will depend on the presence of comorbidities.
The European Society of Cardiology (ESC), for patients older than 80 years advises a threshold of ≥160/≥90mmHg equally in diabetes, CAD, CKD or stroke.²
References
- Murad, Mohammad Hassan et al. (2019) Anti-hypertensive agents in older adults: A systematic Review and Meta-analysis of Randomized Clinical Trials. The Journal of clinical endocrinology and metabolism. [Online]
- Bergler-Klein, Jutta & Bergler-Klein, Jutta (2019) What’s new in the ESC 2018 guidelines for arterial hypertension : The ten most important messages. Wiener klinische Wochenschrift. [Online] 131 (7-8), 180–185. [online]. Available from: http://search.proquest.com/docview/2179505220/.
