2014 UPDATE ON MANAGEMENT OF HYPERTENSION


Wilbert S. Aronow, M.D., Westchester Medical Center/New York Medical College, Valhalla, NY, USA

The American College of Cardiology Foundation/American Heart Association 2011 expert consensus document on hypertension in the elderly recommended the blood pressure (BP) in patients with primary hypertension or in patients at high risk for cardiovascular events such as those with coronary heart disease, stroke, peripheral arterial disease, diabetes, chronic kidney disease, and heart failure be less than 140/90 mm Hg in adults with hypertension younger than 80 years and the systolic BP reduced to 140-145 mm Hg if tolerated in persons with hypertension aged 80 years and older. The European Society of Hypertension/European Society of Cardiology 2013 hypertension guidelines recommended that reducing BP to <130/80 mm Hg in patients at high risk for cardiovascular events was unsupported by prospective trial data and that the systolic BP should be reduced to <140 mm Hg in these patients with hypertension younger than 80 years and to between 140-150 mm Hg in patients aged 80 years and older. The Eighth Joint National Committee on hypertension 2014 guidelines recommended treating adults with primary hypertension or hypertension associated with diabetes or nondiabetic chronic kidney disease younger than 60 years to a BP goal of <140/90 mm Hg and in adults aged 60 years and older to a BP goal of <150/90 mm Hg. The ongoing Reasons for Geographic Differences in Stroke (REGARDS) study of 13,948 adults aged =55 years showed that the systolic BP should be reduced to <140 mm Hg for optimal reduction of cardiovascular events including in the 1,839 patients aged 75 years and older.