What is the optimal blood pressure (BP) target when treating older adults with high blood pressure?
Elevated BP in older adults is common and higher pressures increase the risk of adverse health events such as stroke, heart attack, heart failure, and death. Lowering BP with drugs has been shown to reduce the risk of these serious health events but the optimal BP target when treating older adults is not known.
We systematically retrieved all randomised trials that compared the effect of a higher BP target (upper BP number less than 150 to 160 mmHg) with a conventional lower BP target (upper BP number less than140 mmHg) in people over the age of 65 years. The evidence is current to February 2017.
We found three randomised trials (the ‘gold standard’ of medical evidence) that investigated this question in a total of 8221 older adults (average age 75 years, 59% female). We did not find a difference between the higher BP target and the conventional lower BP target, however an important difference favoring the lower BP target could not be ruled out.
Quality of the evidence
We judged the pooled evidence to be of low-quality and not able to adequately answer the question as to which target BP was better. More good-quality trials addressing this question are needed.
At the present time there is insufficient evidence to know whether a higher BP target (less than150 to 160/95 to 105 mmHg) or a lower BP target (less than 140/90 mmHg) is better for older adults with high BP. Additional good-quality trials assessing BP targets in this population are needed.