The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have released a joint practice guideline on systolic blood pressure targets for people aged 60 years and older with hypertension.
The guidance calls for physicians to start treatment for patients who have persistent systolic blood pressure at or above 150 mm Hg to achieve a target of less than 150 mm Hg to reduce risk for stroke, cardiac events, and death. The recommendation was rated strong, with high-quality evidence.
"The evidence showed that any additional benefit from aggressive blood pressure control is small, with a lower magnitude of benefit and inconsistent results across outcomes," ACP's President Nitin S. Damle, MD, said in a news release.
However, in some cases, a lower systolic target should be considered, according to the guidelines.
If patients have a history of stroke or transient ischemic attack or have high cardiovascular risk, physicians should consider starting or increasing drug therapy to achieve systolic blood pressure of less than 140 mm Hg to reduce risk for stroke and cardiac events. The authors note, however, that this recommendation was rated weak, with moderate-quality evidence.
High cardiovascular risk generally includes patients with diabetes, vascular disease, metabolic syndrome, or chronic kidney disease, as well as older adults.