Is Intensive Blood Pressure Control Indicated in Older Patients with Hypertension?

This review aims to evaluate intensive blood pressure control in older adults, assessing its necessity, effectiveness, benefits and risks including cardiovascular outcomes, adverse events, quality of life, and overall mortality.

Recent studies have supported that intensive antihypertensive treatment lowers the rates of cardiovascular events compared to standard treatment in older patients with hypertension, and it may also reduce the risk of cognitive decline.

Intensive blood pressure lowering strategies are associated with reduced risk of cardiovascular morbidity and mortality as well as all-cause mortality, without compromising quality of life or functional status, and are relatively well tolerated in this patient population. Evidence suggests that maintaining systolic blood pressure below 130 mm Hg can yield cardiovascular and cognitive benefits in older patients with hypertension, particularly among those at risk of myocardial infarction or stroke. However, clinicians should vigilantly monitor for adverse events and engage in shared decision-making when pursuing intensive blood pressure goals tailored to individual risks and benefits.