+AA
Fr
Back
Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

In 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

 




Glossary

Diastolic
The lower number in a blood pressure reading. It is the pressure when the heart rests between beats.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Risk factors
Aspects making a condition more likely.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
Systolic
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.
Vascular
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Web Resources

  • Blood pressure screening

    Health Link B.C.
    The Canadian Hypertension Education Program recommends that all adults get their blood pressure tested when they visit the doctor. If you are at risk for heart disease or a disease caused by high blood pressure, you should get your blood pressure checked more often.
  • The evidence on salt? The jury is still out

    Evidence-based Living
    Eating too much salt can make existing high blood pressure and heart disease worse. More unbiased and high quality research is needed to know whether salt intake is really a risk for healthy adults.
  • Salt and sodium: Heart risks and disease

    Harvard School of Public Health
    Eating too much salt can increase your blood pressure and lead to heart disease, especially if you are over 50, have high blood pressure or diabetes, or are African American. Try to eat less than a teaspoon of salt a day.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Register
Want the latest in aging research? Sign up for our email alerts.
Subscribe

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use