Hypertension prevalence increases with advancing age, and helping older patients reach goal blood pressure can be challenging due to conflicting guidelines on age-based targets. A recent review in Hypertension found that, for older adults whose hypertension was assessed during a primary care visit, appropriate medication regimen intensification occurred for only 30%.1
The review compiled 10 years of data, spanning 2008-2018, from the National Ambulatory Medical Care Survey. Blood pressure medication changes were reviewed for appropriateness in accordance with these guidelines: the 2017 American College of Cardiology/American Heart Association (Age ≥ 65, intensify when systolic blood pressure [SBP] ≥130), the 2018 European Society of Cardiology (Age > 65 and ≤80, intensify when SBP≥ 140), and the 2017 American College of Physicians/American Academy of Family Physicians (Age ≥60, intensify when SBP ≥150). Varying guideline targets, prescriber inertia, and systemic and patient factors were noted to contribute to the lack of appropriate up-titration.
Growing evidence points to cardiovascular benefits for older adults resulting from tighter control of hypertension; appropriate intensification may prevent major cardiovascular events and mortality. 2-4
- Chiu N, Chiu L, Aggarwal R, et al. Trends in blood pressure treatment intensification in older adults with hypertension in the United States, 2008 to 2018. Hypertension. 2023;80(3):553-562. doi:10.1161/HYPERTENSIONAHA.122.19882.
- Zhang W, Zhang S, Deng Y, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med. 2021;385(14):1268– 1279. doi: 10.1056/NEJMoa2111437.
- Wright JT Jr, Whelton PK, Johnson KC, et al. SPRINT Revisited: updated results and implications. Hypertension. 2021;78(6):1701-1710. doi:10.1161/HYPERTENSIONAHA.121.17682.
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115. doi:10.1161/HYP.0000000000000065.