What is the blood pressure goal for the elder patient 75 years of age or older?

High blood pressure (BP), once believed to represent a normal and progressive component of the aging process, is now recognized as a manifestation of structural and physiologic abnormalities of arterial function. Two phenotypes exist in the older patient: elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) with a normal pulse pressure (PP), and elevated SBP with an increased PP. Elevated SBP and increased PP unquestionably increase the risk of both fatal and nonfatal cardiovascular events, including stroke, myocardial infarction, and heart failure. Isolated systolic hypertension, defined as an SBP ≥140 mm Hg with a DBP less than 90 mm Hg, affects the majority of individuals ages 60 years and older. A number of clinical trials have clearly demonstrated that treatment of hypertension significantly reduces the cardiovascular event rate in older patients. However, controversy continues as to the choice of antihypertensive agents and combinations of agents. It is both appropriate and necessary to treat elderly hypertensive patients aggressively to the same target BPs identified for younger patients. It is also appropriate to initiate treatment with lower doses of antihypertensive agents and to bring the pressure down more slowly, monitoring for orthostatic hypotension, impaired cognition, and electrolyte abnormalities.