First Clinical Guidance for Controlling High Blood Pressure in the Elderly Released

Faced with an aging patient population and compelling data that confirm the benefits of blood pressure-lowering medications in seniors 80 years and older, the American College of Cardiology and the American Heart Association have released the first expert consensus document to help clinicians manage or reduce the risk of hypertension in older adults.

Some of the recommendations addressed in the new consensus document include:

● A therapeutic target of less than 140/90 mmHg in persons 65-79 years and a systolic blood pressure between 140 and 145 mmHg in persons 80 years and older if tolerated were discussed.

● Angiotensin converting enzyme (ACE) inhibitors, beta blockers, angiotensin receptor blockers, diuretics and calcium channel blockers are all effective in lowering blood pressure and reducing cardiovascular outcomes among the elderly; clinicians should select medications based on efficacy, tolerability, specific comorbidities and cost. (For example, if someone has had a heart attack, they should be started on a beta blocker and an ACE inhibitor.)

● Initiation of antihypertensive drugs in this population should generally be at the lowest dose with gradual increments as tolerated.

● Routine monitoring of blood pressure, including taking blood pressure measures in the standing position.

● Encouragement of lifestyle changes to prevent and treat hypertension among older adults, such as regular physical activity, restriction of salt, weight control, smoking cessation and avoiding excessive alcohol intake.

Experts say the high cost of blood pressure lowering medications also contributes to low rates of blood pressure control in the elderly and should be discussed with patients.

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ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly