Hypertension Management in Older Adults with History of Coronary Artery Disease (CAD) The hypertension treatment goals for older patients according to American and European guidelines are listed in Table 1.

Treatment side effects must be closely monitored, particularly for those who are frail.Įven though the definitions and treatment thresholds differ between the American and European guidelines, both acknowledge the importance of BP treatment in older adults to lower atherosclerotic cardiovascular disease (ASCVD) risk but recommend a cautious approach and close monitoring of these patients. 9 These decisions should be based on clinical assessment of biological age and a thorough review of comorbidities. Pharmacologic therapy may also be considered in fit individuals >80 years with an initial SBP ≥160 mmHg and/or DBP ≥90 mmHg while targeting a BP of 130-139/70-79 mmHg. Table 1: A Comparison of Blood Pressure Thresholds and Targets between ACC/AHA, ACP/AAFP, and ESC/ESH GuidelinesīP Threshold for Initiation of PharmacotherapyĨ0 years) patients. Pharmacotherapy is recommended for persistently elevated systolic BP (SBP) ≥150 mmHg to reduce the risk of atherosclerotic cardiovascular disease (ASCVD) ( Table 1). In January 2017, the American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) released guidelines for BP management in adults ≥60 years.

Hypertension guidelines published by several major medical societies highlight the challenges of managing BP in older patients. 3 Furthermore, chronological age cutoffs used to identify older patients across guidelines are inconsistent and BP treatment targets remain controversial. With advancing age, the gap between chronological and biological age widens and chronological age may be a poor surrogate for biological age. This group has been traditionally excluded or underrepresented in clinical trials due to concerns regarding frailty, fall risk, poor renal function, abnormal hemodynamic adaptation, and higher risk for autonomic dysfunction, cognitive impairment, and polypharmacy. 2ĭespite having the highest prevalence of hypertension and greatest risk for CV morbidity and mortality, older adults are frequently undertreated for elevated blood pressure (BP). 1 This number will continue to rise as our population ages as 15% of the US population was ≥65 years old in 2014 and this is expected to increase to 20% by 2050. According to the US National Health and Nutrition Examination Survey (NHANES), 70% of adults ≥65 years have hypertension. Hypertension is one of the primary modifiable risk factors for cardiovascular (CV) disease and its prevalence and severity both increase with age. Epidemiology of Hypertension in Older Adults

Blood pressure chart for seniors 2021