Unknown areas in target BP and therapeutic goals in the elderly with hypertension

Dr Giuseppe Mancia is an emeritus professor of medicine at the University of Milano-Bicocca (Italy) and past president of the International Society of Hypertension and the European Society of Hypertension.

Are there still any unknown areas concerning target blood pressure (BP) values and therapeutic goals in older patients with hypertension?

Giuseppe Mancia, MD, PhD: Target BP has been lowered to less than 130 mm Hg systolic and less than 80 mm Hg diastolic mainly because of data from meta-analyses from randomized clinical trials, rather than less than 140/90 and less than 150/90 in the elderly as it was before.

Now, I think, the goal is more ambitious in a way. The evidence is there can be an incremental benefit if we go lower both in younger patients and—to a higher level—in elderly patients. However, these data have also shown that the greater is the BP fall, the greater is the number of serious side effects, those leading to treatment discontinuation, and treatment discontinuation is accompanied by a marked increase in cardiovascular risk. So it is obvious that aggressiveness in treatment leads to a sort of a balance, to double effect—greater benefit but also greater harm. I think it is up to the physician to see in individual patients what the proper target could be in that particular situation.