Hypertension Goals for the Older Adult Patient

What is the goal for hypertension numbers as people age?

A brief conversation with Marigel Constantiner, RPh, MSc, BCPS, CGP, CPh, and Stephanie Yager, PharmD

The goal blood pressure as people age remains controversial.

The Eighth Joint National Committee (JNC 8) panel recommended a blood pressure goal in adults ≥ 60 years of <150/90 mmHg or <140/90 mmHg if diabetes or chronic kidney disease is present1.

Diabetes guidelines2 agree with targeting <140/90 mmHg and kidney guidelines3 suggest targeting <130/80 mmHg in patients with albuminuria.

The American Heart Association recommended a target of <140/90 mmHg for all adults4 while the European guidelines recommend targeting a systolic blood pressure goal of 140-150 mmHg in elderly patients (above 80 years old)5.

Meanwhile, the SPRINT trial showed targeting a systolic blood pressure <120 mmHg reduced heart failure and death in non-diabetic adults age ≥ 50 years6.The SPRINT trial also excluded patients with stroke, dementia, and nursing home residents.

In January 2017, the American College of Physicians and American Academy of Family Physicians published a guideline recommending targeting a systolic blood pressure of <150 mmHg in adults ≥ 60 years, but consider targeting <140 mmHg if the patient has a history of stroke or TIA7.

Overall, guidelines recommend targeting anywhere from <130/80 mmHg to <150/90 mmHg in older adults. Blood pressure goals are not one-size fits all. Treatment goals should be tailored to the specific patient based on comorbidities, cardiovascular risk, functional status, life-expectancy, fall risk, and tolerability of pharmacologic therapy.

Marigel Constantiner, RPh, MSc, BCPS, CGP, CPh, is specialized as a drug information pharmacist and preceptor at Cleveland Clinic with a special interest in geriatrics. She can be reached at constam@ccf.org or 216.444.1126. Stephanie Yager, PharmD, was an ambulatory care pharmacy resident at Cleveland Clinic’s main campus.

References

1. 2014;311(5):507-520.
2. Diabetes Care. 2017 Jan;40(Suppl 1):S1-S2.
3. Kidney International Supplements (2012) 2, 337
4. 2014;63:878-885
5. J Hypertens.2013 Jul;31(7):1281-357
6. N Engl J Med 2015;373:2103-16
7. Ann Intern Med.2017 Jan 17.