Among nearly 13,000,000 persons in the United States aged 80 years or older, proximately 80% have hypertension.
Hypertension is the most potent modifiable risk factor for cardiovascular disease in older adults.
Hypertension in the elderly is strongly associated with stroke, myocardial infarction, heart failure, peripheral artery disease, kidney disease, and dementia.
The HYVET study found that octogenarians with a systolic blood pressure of 160 mmHg or more treated to a target blood pressure of 150/80 mmHg experienced or 30% relative reduction in stroke risk, a 64% relative reduction in heart failure risk, and a 21% relative reduction in mortality.
The SPRINT study showed that even more aggressive treatment than above conferred a greater benefit with patients aged 75 years or older lowering the systolic blood pressure target from 140 mmHg to 120 mmHg is associated with a 34% relative reduction of myocardial infarction, stroke, heart failure, or cardiovascular death.
When treating elderly with hypertension aggressively as in the SPRINT trial the risk for complications including hypotension, syncope, electrolyte abnormalities, and acute kidney injury are increased compared with less intensive therapy.
American College of cardiology and the American heart Association guidelines recommend treatment guidelines for is blood pressure should be lower than 130/80 mmHg for all patients irrespective of age.