Blood pressure targets for people 65 to 80

[JimJimJimJim]

The American College of Cardiology and the American Heart Association have issued the first guidance specifically for the treatment of hypertension in patients 65 and older in the form of an expert consensus document.

In general, the target blood pressure should be less than 140/90 mm Hg, although the authors acknowledged that there was some uncertainty about whether patients 80 and older should have a different goal than those ages 65 to 79.

A systolic target of 140 to 145 mm Hg would be acceptable for patients who have reached 80, noted the writing committee, co-chaired by Wilbert Aronow, MD, of New York Medical College, Jerome Fleg, MD, of the National Heart, Lung and Blood Institute, and Carl Pepine, MD, of the University of Florida.

This is a consensus document. That means the evidence is not clear enough to make it a guideline.

• Although the general target blood pressure is less than 140/90 mm Hg, certain patient groups, including those with coronary artery disease, diabetes, and chronic kidney disease, should aim for less than 130/80 mm Hg.
  
• Lifestyle changes may be all that is needed to manage milder forms of hypertension. Those changes include increasing physical activity, reducing salt intake, controlling weight, stopping smoking, and limiting alcohol intake to two drinks a day or less. If modifying lifestyle does not work, then drugs can be considered.
  
• When drug treatment is initiated, start patients on the lowest dose of a single drug and gradually increase it. Thiazide diuretics, chlorthalidone, and bendroflumethiazide are recommended for initiating therapy. If a diuretic is not the first drug, it is usually recommended as the second drug when needed.
  
• Consider starting with two drugs when the blood pressure is more than 20/10 mm Hg over the goal.
  
• In hypertensive patients with coronary artery disease and stable angina or prior myocardial infarction, the initial choice should be a beta-blocker. A long-acting dihydropyridine calcium antagonist should be added when the pressure remains elevated or if angina persists.
  
• Screening for albuminuria is recommended for all elderly hypertensive patients with concomitant diabetes and for those with mild and moderate chronic kidney disease.
  
• The diagnosis of hypertension should be made based on at least three blood pressure readings at two or more office visits

The article, and a link to the full document (free) can be found at:

http://www.medpageto...ertension/26110

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The full consensus document is 80 pages, and obviously requires medical education to interpret. As always, check with your doctor if anything here is of interest.