< 150 mm Hg or diastolic blood pressure < 90 mm Hg.

Choosing Wisely:

Don’t initiate antihypertensive treatment in individuals ≥ 60 years of age for systolic blood pressure < 150 mm Hg or diastolic blood pressure < 90 mm Hg.

Rationale and Comments: There is strong evidence for the treatment of hypertension in older adults. Achieving a goal systolic blood pressure of 150 mm Hg reduces stroke incidence, all-cause mortality, and heart failure. Target systolic and diastolic blood pressure levels should be set cautiously, however, as data do not suggest benefit in treating more aggressively to a goal systolic blood pressure of < 140 mm Hg in the general population ≥ 60 years of age. Furthermore, moderate- or high-intensity treatment of hypertension has been associated with an increased risk of serious fall injury in older adults.
Sponsoring Organizations:
  • Society for Post-Acute and Long-Term Care Medicine
  • Sources:
  • Eighth Joint National Committee guideline
  • Disciplines:
  • Cardiovascular
  • References: • Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, Banya W, Bulpitt CJ; HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008 May 1; 358(18):1887-98.
    • James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E. 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA. 2014 Feb 5;311(5):507-20.
    • Muntner P, Bowling CB, Shimbo D. Systolic blood pressure goals to reduce cardiovascular disease among older adults. Am J Med Sci. 2014 Aug;348(2):129-34.
    • Tinetti ME, Han L, Lee DSH, McAvay GJ, Peduzzi P, Gross CP, Zhou B, Lin H. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014 Apr;174(4):588-95.

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