A systematic review of hypertension outcomes and treatment strategies in older adults.

Objective: To evaluate the literature regarding blood pressure control and management in older adult patient population over 70 years of age.

Methods: A literature search was conducted using PubMed and capturing the data from 2006 to 2016. Terms used included MeSH headings for hypertension/therapy and antihypertension agents. A systematic review of published studies was performed. Articles including older patients (average age 70 years or older) being treated for hypertension were included. We analyzed the blood pressure goals and treatment regimens along with cardiovascular outcomes.

Results: Six trials were evaluated that met criteria for inclusion. A range of countries were represented including Europe, China, Australia, Tunisia, US, and Japan. The population size in the trials ranged from 142 to 4736. All studies included had adequate power to assess treatment effects. Blood pressure goals were variable and ranged from a systolic of <120 to <160 with a diastolic goal of <80mmHg. Some studies reported outcomes including all-cause mortality, composite cardiovascular events, cardiovascular mortality, fatal and non-fatal stroke or myocardial infarction, and fatal or nonfatal heart failure. Many trials were stopped early because of the significant findings in mortality and cardiovascular outcomes.

Conclusions: The studies discussed had a range of blood pressure goals. The optimal management of hypertension in older adults is still being debated. Data from the clinical trials show that treating blood pressure to tight goals of at least <140/80, or lower if tolerated, confers benefit in cardiovascular outcomes.