What Updated Blood Pressure Guidelines Mean for Older Adults

November 14, 2017

According to the new guidelines for blood pressure released by the American Heart Association and American College of Cardiology, anyone with blood pressure (BP) higher than 130/80 will be considered to have hypertension.

Paul Whelton, MD, MSc, Tulane University (New Orleans, LA), who chaired the committee that wrote the guidelines, said: “It’s very clear that lower is better,” and these results “are based on strong evidence” (NBC News. November 14, 2017)

This means, according to the joint statement, that “rather than one in three U.S. adults having high blood pressure (32 percent) with the previous definition, the new guidelines will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, or hypertension.”

For older adults, the joint statement recommends treatment of hypertension “with a SBP treatment goal of less than 130 mm Hg for noninstitutionalized ambulatory community-dwelling adults (≥ 65 years of age) with an average SBP of 130 mm Hg or higher.

For those with hypertension and a high burden of comorbidity and limited life expectancy, the guidelines recommend that providers employ “clinical judgment, patient preference, and a team-based approach to assess risk/benefit” to come to reasonable treatment decisions.

Authors acknowledge the difficulty in treating elevated BP in this medically complex population, but cite studies over the past 3 decades that have included large numbers of older adults and summarize their recommendations:

“In summary, despite the complexity of management in caring for older persons with hypertension, RCTs have demonstrated that in many community-dwelling older adults, even adults >80 years of age, BP-lowering goals during antihypertensive treatment need not differ from those selected for persons <65 years of age” (Hypertension. 2017; doi: 10.1161/HYP.0000000000000065).

Authors are careful to point out, however, that “clinicians should implement careful titration of BP lowering and monitoring in persons with high comorbidity burden; large RCTs have excluded older persons at any age who live in nursing homes, as well as those with prevalent dementia and advanced HF.”—Amanda Del Signore

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