What is an appropriate blood pressure goal for the elderly: Review of recent studies and practical recommendations

Clinical Interventions in Aging

Volumn 8, Issue , 2013, Pages 1505-1516

  Denker, Matthew G ^a   Cohen, Debbie L ^a  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

Antihypertensive treatment; Blood pressure target; Elderly; Hypertension

Indexed keywords

ALPHA TOCOPHEROL; AMILORIDE PLUS HYDROCHLOROTHIAZIDE; AMLODIPINE; ANGIOTENSIN RECEPTOR ANTAGONIST; ASCORBIC ACID; ATENOLOL; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM CHANNEL BLOCKING AGENT; CAPTOPRIL; CAPTOPRIL PLUS HYDROCHLOROTHIAZIDE; CATECHOLAMINE; CHLORTALIDONE; DIHYDROPYRIDINE; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DIURETIC AGENT; ENALAPRIL; ENALAPRIL PLUS HYDROCHLOROTHIAZIDE; HYDROCHLOROTHIAZIDE PLUS TRIAMTERENE; INDAPAMIDE; LISINOPRIL; LOSARTAN; METHYLDOPA; METOPROLOL; NIFEDIPINE; NITRENDIPINE; PERINDOPRIL; PINDOLOL; PLACEBO; THIAZIDE DIURETIC AGENT; UNINDEXED DRUG;

ADVERSE OUTCOME; AGE DISTRIBUTION; ANTIHYPERTENSIVE THERAPY; ANTIOXIDANT ACTIVITY; BLOOD PRESSURE FLUCTUATION; BLOOD PRESSURE MEASUREMENT; BLOOD PRESSURE REGULATION; BRAIN PERFUSION; BRONCHOSPASM; CARDIOVASCULAR DISEASE; CARDIOVASCULAR RISK; CAUSE OF DEATH; CELL MIGRATION; CEREBROVASCULAR ACCIDENT; CLINICAL DECISION MAKING; CLINICAL FEATURE; CLINICAL TRIAL (TOPIC); COMORBIDITY; CORONARY ARTERY ATHEROSCLEROSIS; CORONARY ARTERY BLOOD FLOW; COUGHING; CREATININE BLOOD LEVEL; DEATH; DEPRESSION; DIASTOLIC BLOOD PRESSURE; DISEASE ACTIVITY; DISEASE ASSOCIATION; DISEASE PREDISPOSITION; DIURETIC THERAPY; DRUG DOSE INCREASE; EDEMA; ELASTICITY; FATIGUE; FOLLOW UP; GERIATRIC PATIENT; HEART FUNCTION; HEART LEFT VENTRICLE HYPERTROPHY; HUMAN; HYPERGLYCEMIA; HYPERKALEMIA; HYPERTENSION; HYPERURICEMIA; HYPOCALCIURIA; HYPOKALEMIA; HYPONATREMIA; IMPOTENCE; LIFESTYLE MODIFICATION; NONHUMAN; ORTHOSTATIC HYPOTENSION; OXIDATIVE STRESS; OXYGEN SUPPLY; PATHOPHYSIOLOGY; PERSONALIZED MEDICINE; POPULATION RESEARCH; PRACTICE GUIDELINE; PROTEIN FUNCTION; RANDOMIZED CONTROLLED TRIAL (TOPIC); RASH; REVIEW; RISK REDUCTION; SIDE EFFECT; SIGNAL TRANSDUCTION; SYSTOLIC BLOOD PRESSURE; SYSTOLIC HYPERTENSION; TREATMENT OUTCOME; VASCULAR SMOOTH MUSCLE; VASOCONSTRICTION;

ANTIHYPERTENSIVE TREATMENT; BLOOD PRESSURE TARGET; ELDERLY; HYPERTENSION;

ADOLESCENT; ADULT; AGED; AGED, 80 AND OVER; ANTIHYPERTENSIVE AGENTS; BLOOD PRESSURE; FEMALE; HUMANS; HYPERTENSION; MALE; MIDDLE AGED; REFERENCE VALUES; YOUNG ADULT;

EID: 84887675682     PISSN: 11769092     EISSN: 11781998     Source Type: Journal    
DOI: 10.2147/CIA.S33087     Document Type: Review

References (68)

1. He W, Sengupta M, Velkoff VA, DeBarros KA; For the US Census Bureau. Current Population Reports, 65 in the United States: 2005. Washington, DC: US Government Printing Office; 2005:P23-P209.
2. Ostchega Y, Dillon CF, Hughes JP, Carroll M, Yoon S. Trends in hypertension prevalence, awareness, treatment, and control in older US adults: data from the National Health and Nutrition Examination Survey 1988 to 2004. J Am Geriatr Soc. 2007;55(7):1056-1065.
3. Vasan RS, Beiser A, Seshadri S, et al. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA. 2002;287(8):1003-1010.
4. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008; 51(6):1403-1419.
5. Hayes DK, Denny CH, Keenan NL, Croft JB, Greenlund KJ. Health-related quality of life and hypertension status, awareness, treatment, and control: National Health and Nutrition Examination Survey, 2001-2004. J Hypertens. 2008;26(4):641-647.
6. Lawes CM, Vander Hoorn S, Rodgers A; International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371(9623):1513-1518.
7. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.2002;360(9349):1903-1913.
8. Gorelick PB, Sacco RL, Smith DB, et al. Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA. 1999;281(12):1112-1120.
9. Franklin SS, Jacobs MJ, Wong ND, L'Italien GJ, Lapuerta P. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension. 2001;37(3):869-874.
10. Franklin SS, Larson MG, Khan SA, et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation. 2001;103(9):1245-1249.
11. Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension. 1995;25(3):305-313.
12. Ungvari Z, Kaley G, de Cabo R, Sonntag WE, Csiszar A. Mechanisms of vascular aging: new perspectives. J Gerontol A Biol Sci Med Sci. 2010;65(10):1028-1041.
13. Wang M, Takagi G, Asai K, et al. Aging increases aortic MMP-2 activity and angiotensin II in nonhuman primates. Hypertension. 2003;41(6): 1308-1316.
14. Wang M, Zhang J, Spinetti G, et al. Angiotensin II activates matrix metalloproteinase type II and mimics age-associated carotid arterial remodeling in young rats. Am J Pathol. 2005;167(5):1429-1442.
15. Chabrashvili T, Kitiyakara C, Blau J, et al. Effects of ANG II type 1 and 2 receptors on oxidative stress, renal NADPH oxidase, and SOD expression. Am J Physiol Regul Integr Comp Physiol. 2003;285(1): R117-R124.
16. Basso N, Cini R, Pietrelli A, Ferder L, Terragno NA, Inserra F. Protective effect of long-term angiotensin II inhibition. J Physiol Heart Circ Physiol. 2007;293(3):H1351-H1358.
17. Lakatta EG. Cardiovascular regulatory mechanisms in advanced age. Physiol Rev. 1993;73(2):413-467.
18. Gribbin B, Pickering TG, Sleight P, Peto R. Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res. 1971;29(4):424-431.
19. Vita JA, Keaney JF. Exercise-toning up the endothelium? N Engl J Med. 2000;342(7):503-505.
20. Ulker S, McKeown PP, Bayraktutan U. Vitamins reverse endothelial dysfunction through regulation of eNOS and NAD(P)H oxidase activities. Hypertension. 2003;41(3):534-539.
21. d'Uscio LV, Milstien S, Richardson D, Smith L, Katusic ZS. Long-term vitamin C treatment increases vascular tetrahydrobiopterin levels and nitric oxide synthase activity. Circ Res. 2003;92(1):88-95.
22. Yusuf S, Dagenais G, Pogue J, Bosch J, Sleight P. Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342(3):154-160.
23. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360(9326):23-33.
24. de Gaetano G; Collaborative Group of the Primary Prevention Project. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Collaborative Group of the Primary Prevention Project. Lancet. 2001;357(9250):89-95.
25. Ghiadoni L, Magagna A, Versari D, et al. Different effect of antihypertensive drugs on conduit artery endothelial function.2003;41(6):1281-1286.
26. Berry C, Anderson N, Kirk AJ, Dominiczak AF, McMurray JJ. Renin angiotensin system inhibition is associated with reduced free radical concentrations in arteries of patients with coronary heart disease. Heart. 2001;86(2):217-220.
27. On YK, Kim CH, Oh BH, Lee MM, Park YB. Effects of angiotensin converting enzyme inhibitor and calcium antagonist on endothelial function in patients with essential hypertension. Hypertens Res. 2002;25(3):365-371.
28. Mason RP, Marche P, Hintze TH. Novel vascular biology of third-generation L-type calcium channel antagonists: ancillary actions of amlodipine. Arterioscler Thromb Vasc Biol. 2003;23(12):2155-2163.
29. Collins R, MacMahon S. Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull. 1994;50(2):272-298.
30. Staessen JA, Gasowski J, Wang JG, et al. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet. 2000;355(9207):865-872.
31. Julius S, Kjeldsen SE, Weber M, et al; VALUE trial group. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet. 2004;363(9426):2022-2031.
32. Messerli FH, Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006;144(12):884-893.
33. Sleight P, Redon J, Verdecchia P, et al; ONTARGET investigators. Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens. 2009;27(7):1360-1369.
34. Bangalore S, Messerli FH, Wun CC, et al; Treating to New Targets Steering Committee and Investigators. J-curve revisited: An analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Heart J. 2010;31(23):2897-2908.
35. Boshuizen HC, Izaks GJ, van Buuren S, Ligthart GJ. Blood pressure and mortality in elderly people aged 85 and older: community based study. BMJ. 1998;316(7147):1780-1784.
36. Langer RD, Ganiats TG, Barrett-Connor E. Factors associated with paradoxical survival at higher blood pressures in the very old. Am J Epidemiol. 1991;134(1):29-38.
37. Hakala SM, Tilvis RS, Strandberg TE. Blood pressure and mortality in an older population. A 5-year follow-up of the Helsinki Ageing Study. Eur Heart J. 1997;18(6):1019-1023.
38. van Bemmel T, Gussekloo J, Westendorp RG, Blauw GJ. In a population-based prospective study, no association between high blood pressure and mortality after age 85 years. Hypertens. 2006;24(2):287-292.
39. Molander L, Lövheim H, Norman T, Nordström P, Gustafson Y. Lower systolic blood pressure is associated with greater mortality in people aged 85 and older. J Am Geriatr Soc. 2008;56(10):1853-1859.
40. Satish S, Freeman DH, Ray L, Goodwin JS. The relationship between blood pressure and mortality in the oldest old. J Am Geriatr Soc. 2001;49(4):367-374.
41. Boutitie F, Gueyffier F, Pocock S, Fagard R, Boissel JP; INDANA Project Steering Committee. Individual data analysis of Antihypertensive intervention. J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med. 2002;136(6):438-448.
42. Chobanian AV, Bakris GL, Black HR, et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-2572.
43. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159-2219.
44. Brandão Rondon MU, Alves MJ, Braga AM, et al. Postexercise blood pressure reduction in elderly hypertensive patients. J Am Coll Cardiol. 2002;39(4):676-682.
45. Appel LJ, Espeland MA, Easter L, Wilson AC, Folmar S, Lacy CR. Effects of reduced sodium intake on hypertension control in older individuals: results from the Trial of Nonpharmacologic Interventions in the Elderly (TONE). Arch Intern Med. 2001;161(5):685-693.
46. Amery A, Birkenhager W, Brixko P, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet. 1985;1(8442):1349-1354.
47. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991;265(24):3255-3264.
48. Perry HM, Davis BR, Price TR, et al. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 2000;284(4):465-471.
49. Dahlöf B, Lindholm LH, Hansson L, Scherstén B, Ekbom T, Wester PO. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet. 1991;338(8778):1281-1285.
50. Hansson L, Lindholm LH, Ekbom T, et al. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet. 1999;354(9192):1751-1756.
51. Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350(9080):757-764.
52. Liu L, Wang JG, Gong L, Liu G, Staessen JA. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens. 1998;16(12 Pt 1):1823-1829.
53. Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party.1992;304(6824): 405-412.
54. Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis. CMAJ. 2006;174(12): 1737-1742.
55. Dahlöf B, Devereux RB, Kjeldsen SE, et al; LIFE Study Group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359(9311):995-1003.
56. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-2997.
57. Wing LM, Reid CM, Ryan P, et al; Second Australian National Blood Pressure Study Group. A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med. 2003;348(7):583-592.
58. Jamerson K, Weber MA, Bakris GL, et al; ACCOMPLISH Trial Investigators. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. Engl J Med. 2008;359(23):2417-2428.
59. Gueyffier F, Bulpitt C, Boissel JP, et al. Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group. Lancet. 1999;353(9155):793-796.
60. Beckett NS, Peters R, Fletcher AE, et al; HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887-1898.
61. Ogihara T, Saruta T, Rakugi H, et al; Valsartan in Elderly Isolated Systolic Hypertension Study Group. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study. Hypertension. 2010;56(2):196-202.
62. JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res. 2008;31(12):2115-2127.
63. Strandgaard S. Cerebral blood flow in the elderly: impact of hypertension and antihypertensive treatment. Cardiovasc Drugs Ther. 1991;4 Suppl 6:1217-1221.
64. Mansoor GA, McCabe EJ, White WB. Determinants of the white-coat effect in hypertensive subjects. J Hum Hypertens. 1996;10(2):87-92.
65. Ward AM, Takahashi O, Stevens R, Heneghan C. Home measurement of blood pressure and cardiovascular disease: systematic review and meta-analysis of prospective studies. J Hypertens. 2012;30(3):449-456.
66. Wang JG, Staessen J. Benefits of antihypertensive pharmacologic therapy and blood pressure reduction in outcome trials. J Clin Hypertens (Greenwich). 2003;5(1):66-75.
67. Aronow WS, Fleg JL, Pepine CJ, et al; ACCF Task Force. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation. 2011; 123(21):2434-2506.
68. Sacktor N, Gray S, Kawas C, Herbst J, Costa P, Fleg J. Systolic blood pressure within an intermediate range may reduce memory loss in an elderly hypertensive cohort. J Geriatr Psychiatry Neurol. 1999; 12(1):1-6.