Mild Blood Pressure Control Adequate for Hypertensive Older Adults

New research suggests strict antihypertensive medication use to lower systolic blood pressure (SBP) offers no clear benefit in older adults with hypertension, so mild control is acceptable for those aged 65 years or older.

The research, which was published in the October 2014 edition of Drugs & Aging, confirms recent hypertension guideline changes that recommend maintaining SBP at or below 150 mmHg in adults aged older than 65, which is less intensive than the previously recommended SBP goal of 140 mmHg or less.

Researchers analyzed 31 studies on hypertension, including 7 that examined optimal SBP targets. Although all of the studies consistently found reduced cardiovascular morbidity and mortality with hypertension treatment compared with no treatment, strict SBP control in older adults fared no better than mild control. Additionally, no specific blood pressure control approach was significantly superior to another.

The researchers noted that unwanted side effects associated with higher antihypertensive medication doses, such as an increased risk of falls, can make mild control particularly significant in the older population.

“Keeping SBP in older adults below 150 is important, it’s what we consider a mild level of control,” said lead study author Leah M. Goeres in a press release. “But, for older people, that level is also good enough. After an extensive review, there was no significant evidence that more intensive management is necessary.”

Despite those findings, the researchers said additional research focused on older patient populations is still necessary, because most of the medical guidelines draw upon studies that involve younger adults. Their future research goals include identifying health situations and conditions that benefit from different types of management.

“There’s clearly a value to controlling blood pressure, enough to keep it at 150 or less,” said study author David S. H. Lee in the press release. “Keeping blood pressure within acceptable levels will lower death rates. But, as people get older, there’s less clear evidence that stringent control of SBP is important.”