Hypertension is prevalent in older adults, and blood pressure (BP) level lowering has been shown to be one of the most important clinical interventions to reduce the risk of cardiovascular events. The goal BP level for older adults is individualized based on age, cardiovascular risk, overall health status (particularly frailty), and patient preferences. Recent guidelines differ but a goal systolic BP level lower than 150 mm Hg is reasonable for nearly all adults 60 years and older. In patients with isolated systolic hypertension, the degree to which systolic BP level lowering can be tolerated may be limited if the diastolic BP level decreases below 60 to 65 mm Hg. Orthostatic hypotension is common among older hypertensive patients. Symptoms of light-headedness should prompt an evaluation for orthostatic hypotension and a possible decrease in drug treatment. For relatively healthy older adults at increased cardiovascular risk, a systolic BP level goal lower than 140 mm Hg may be pursued. Although more aggressive BP level lowering is associated with a greater decrease in the number of cardiovascular events, it also is associated with a higher number of adverse events.
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