Appropriate blood pressure (BP) goals for older adults have been debated in recent years. A 2014 guideline ignited controversy by increasing the traditional goal (< 140/90 mmHg) to less than 150/90 for patients age 60 and older. Since then, additional evidence has prompted further controversy.
The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) have issued a new guideline, based on an updated review of studies comparing higher to lower systolic BP (SBP) targets in older adults. The new guideline recommends the following SBP targets for adults age 60 and older: 1) less than 150 mmHg, to reduce the risk of stroke, cardiac events, and death (highquality evidence); 2) less than 140 mmHg for those with a history of stroke or transient ischemic attack, to reduce the risk of recurrent stroke compared with the higher target (moderate-quality evidence); and 3) less than 140 mmHg for some individuals at high cardiovascular risk, to further reduce the risk of stroke and cardiac events (low quality evidence). There was insufficient evidence to set goals for diastolic BP.
Lower versus higher SBP targets resulted in more side effects (including hypotension and fainting, but not falls or fractures). Shared decision- making with patients regarding individualized BP goals was emphasized in the guideline.
• Qaseem A, et al. Ann Intern Med 2017 Jan 17.
• Weiss J, et al. Ann Intern Med 2017 Jan 17.