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Evidence Summary
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Key messages from scientific research that's ready to be acted on
Got It, Hide thisIn people 60 years of age or older, blood pressure targets should be determined based on their history and risk factors
Qaseem A, Wilt TJ, Rich R, et al. Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166:430-7.
Review question
In older adults who have hypertension (high blood pressure), what are the best blood pressure targets?
Background
Blood pressure is reported with 2 numbers, such as 120/80 mm Hg. The first number is the systolic blood pressure and it tells you how much pressure your blood exerts against your artery walls when your heart beats. The second number is the diastolic blood pressure and it tells you how much pressure your blood exerts on your artery walls between heart beats.
Hypertension is blood pressure that is higher than normal. It is a very common disease and increases a person’s risk for other diseases, such as heart attack and stroke, and death. How much a person’s blood pressure should be lowered, especially for people 60 years of age or older, is not known.
How the review was done
The researchers did a systematic review, searching for studies up until September 2016.
They found 21 randomized controlled trials and 3 cohort studies of different blood pressure targets.
The key features of the studies were:
- people were 60 years of age or older and had hypertension; and
- the aim was to lower systolic blood pressure (first number) to less than 150 mm Hg or to less than 140 mm Hg.
What the researchers found
Treatment targets should always be determined after discussion between the person and their doctor about the potential benefits and harms of lowering blood pressure.
Adults 60 years of age or older with systolic blood pressure of 150 mm Hg or more should be treated with a goal of reducing systolic blood pressure to less than 150 mm Hg.
Adults 60 years of age or older who have had a stroke or transient ischemic attack (mini stroke) should be treated with a goal of reducing their systolic blood pressure to less than 140 mm Hg.
Adults 60 years of age or older who are at high risk for cardiovascular events (e.g., heart attack) should be treated with a goal of reducing their systolic blood pressure to less than 140 mm Hg, but this decision should be made on an individual basis.
Conclusion
In adults 60 years of age or older, blood pressure treatment targets should be determined based on a patient’s history and risk factors.
American College of Physicians’ and American Academy of Family Physicians recommendations for people 60 years of age or older with hypertension (high blood pressure)
| Conditions | Recommendations and evidence | Quality rating |
| Adults 60 years of age or older | Treatment targets should always be determined after discussion with the doctor about the potential benefits and harms of lowering blood pressure. | Not applicable |
| Adults 60 years of age or older with systolic blood pressure 150 mm Hg or more | The goal should be to treat to reduce systolic blood pressure to less than 150 mm Hg. | High |
| Adults 60 years of age or older who have had a stroke or transient ischemic attack | The goal should be to treat to reduce systolic blood pressure to less than 140 mm Hg | Moderate |
| Adults 60 years of age or older who are at high risk for cardiovascular events (e.g., heart attack) | The goal of treating to reduce systolic blood pressure to less than 140 mm Hg should be considered, but this decision should be made on an individual basis | Low |
Related Topics
Glossary
The lower number in a blood pressure reading. It is the pressure when the heart rests between beats.
Studies where people are assigned to one of the treatments purely by chance.
Aspects making a condition more likely.
A comprehensive evaluation of the available research evidence on a particular topic.
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.
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