Treatment of hypertension in the elderly: target the lowest well tolerated blood pressure.

Introduction: Clinical trials have shown that antihypertensive treatment provides substantial benefits in older people. However, many challenges remain, including the ideal blood pressure (BP) target to be achieved. Because the elderly population is particularly vulnerable to adverse events, BP control should be carefully managed. Some studies have evaluated the cardiovascular effects of different BP targets in older patients, with mixed results and uncertainty about the most appropriate BP target. However, available data from pooled analyses suggest that intensive BP lowering provides greater cardiovascular protection than less intensive strategies in elderly hypertensive patients.

Areas covered: Understanding the balance between the risks and benefits of intensive BP targets and individualizing treatment is essential to ensure that older hypertensive patients receive appropriate treatment to reduce the risk of cardiovascular complications. To this purpose, we reviewed data from clinical trials which investigated the protective effects of blood pressure lowering drugs in elderly hypertensive patients aged ≥65 years (publication before 31 August 2024, using Medline, SCOPUS, and Web of Science databases).

Expert opinion: Current evidence suggests that age does not preclude an aggressive strategy for treating hypertension in elderly patients. Being 'tolerant' with one hand and 'intensive' with the other should become a universal standard in the management of elderly hypertensive patients. In conclusion, the lowest well-tolerated BP could be a simple and universally applicable BP target in the management of hypertensive patients, including the elderly.