Is 80 the new 60? Management of High Blood Pressure in Older Adults

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An estimated 46 percent of the 65 million persons in the United States with high blood pressure remain untreated, and in 43 percent of treated patients high blood pressure is not controlled to the recommended levels. Age is a risk factor for the development of high blood pressure, and high blood pressure is a major risk factor for heart attack and stroke. A panel of experts (JNC8) recently agreed to increase the blood pressure target to less than 150/90 for adults over age 60 (less than 140/90 for patients with chronic kidney disease or history of heart attack). However, a minority view argues that older adults are at increased risk for morbidity and mortality and goal should remain at less than 140/90. The minority did agree that the blood pressure goal should be less than 150/90 for patients aged 80 or older. This is due to the fact that the risks of aggressive treatment of blood pressure in elderly adults over age 80 may outweigh the benefits. This highlights an evolution in what constitutes old age in this country. When social security was first enacted in 1935, old age was defined as 65 years of age. However, because of advances in medical care, nutrition, and workplace safety Americans are living longer, although not necessarily healthier lives. I like to say that as we age we accumulate the three Ds: diseases, doctors, and drugs. As this most recent JNC8 guideline highlights, the debate over treatment goals in different populations based on age and at what age recommendations should change is ongoing. Clearly, most clinicians continue to treat most patients in their 60s and even 70s as they do younger patients. The minority view to the JNC8 recommendations believe that 80 is the new 60 and should be used as the cut off age for less aggressive treatment of high blood pressure. The ultimate decision about how aggressively to treat high blood pressure depends on multiple factors and is determined by physicians and other prescribers in consultation with each of their patients. National guidelines are just that and each patient is unique regardless of age. Old and old-old are moving targets.     Reference: Wright et al Evidence Supporting a Systolic Blood Pressure Goal of Less than 150mmHg in Patients Aged 60 Years or Older: The Minority View Annals of Internal Medicine January 2014