Blood pressure control in older people

In a recent Editorial, Mattace-Raso e Rajkumar discussed the current evidences about blood pressure (BP) control in elderly people.

Arterial hypertension (AH) is a very well known risk factor for cardiovascular disease and dementia. However, the possible benefits of BP lowering in very old patients are less clear. While the achievement of BP control seems to lower morbidity and mortality also in subjects older than 80 years of age, which target should be chosen is still a matter of debate.

On one side, clinical trials suggest a potential advantage from a more aggressive strategy; conversely, data from large observational cohorts suggest that aiming to BP< 130/80 mmHg might lead to an excess of all-cause mortality. According to these observations, international guidelines suggest not to set the BP target lower than 130/80 in older people.

In this Editorial, the relevance of taking into account the whole complexity of the patient is underlined, since subjects of the same age might be very different.

In conclusion, the authors suggest to comprehensively consider the patient, perform adequate BP measurements, if needed in the standing position, and achieve BP levels of 140/90 mmHg only when well tolerated. For the population >80 years, a target on 150/90 mmHg (standing position) may be more appropriate.

curated by Mattia Bellan