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Blood Pressure Targets for Older Adults Remain Controversial

CardioSmart News

Elderly adults should carefully weigh the risks and benefits of tight blood pressure control, based on a recent analysis that links intensive blood pressure control to increased risk for kidney failure.

Published in the Journal of the American College of Cardiology, this paper addressed the issue of tight blood pressure control in older adults. Until recently, most guidelines have recommended that adults 60 and older keep their systolic blood pressure (the top number in a blood pressure reading) under 140 mmHg. Guidelines are based on a wealth of research linking a lower blood pressure to lower risk for heart disease and life-threatening heart events. Since blood pressure tends to increase with age, keeping a close eye on blood pressure is especially important in older adults.

The problem is that recent findings have cast doubt on aggressive blood pressure control, suggesting that tight of blood pressure control has no proven benefits or worse, could have negative health effects. As a result, the 2014 Eighth Joint National Committee raised the upper limit for systolic blood pressure from 140 mmHg to 150 mmHg for adults ages 60 and over. The change remains controversial, as blood pressure control remains critical for older adults.

To help settle the debate, researchers looked at past trials that tested intensive blood pressure control in older adults. In total, researchers found four trials that included more than 10,800 adults ages 65 and older. All participants had high blood pressure and were assigned to either intensive blood pressure treatment or standard care during the study.

With roughly three years of follow-up in each study, researchers found that lowering systolic blood pressure to 140 mmHg was associated with 29% lower risk of life-threatening heart events compared to standard care. Aggressive blood pressure control was also associated with a 33% reduction in heart-related death and 37% lower risk of heart failure.

The concern was that participants with strict blood pressure control had 19% greater risk of kidney failure, although this difference was not statistically significant. However, a secondary analysis that used a different statistical model confirmed this association, suggesting that intensive blood pressure-lowering therapy more than doubles risk of kidney failure.

Based on findings, authors recommend that clinicians should work with older patients to carefully weigh the risks and benefits of tight blood pressure control. There’s no question that high blood pressure should be closely managed to reduce cardiovascular risk, particularly in older adults. However, exactly what the blood pressure target should be for older adults is less clear. Thus, it’s important that patients work closely with their doctors to set treatment goals that are right for them.

Read the full article in the Journal of the American College of Cardiology. Learn about CardioSmart's editorial process Information provided for educational purposes only. Please talk to your health care professional about your specific needs.