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From the JAMA Network
April 7, 2015

Multiple Blood Pressure Medications and Mortality Among Elderly Individuals

Author Affiliations
  • 1Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York
JAMA. 2015;313(13):1362-1363. doi:10.1001/jama.2015.248

The 2011 American College of Cardiology Foundation/American Heart Association 2011 expert consensus document on hypertension in elderly individuals, developed in collaboration with the American Academy of Neurology, the American Geriatrics Society, the American Society for Preventive Cardiology, the American Society of Hypertension, the American Society of Nephrology, the Association of Black Cardiologists, and the European Society of Hypertension, recommended lowering the systolic blood pressure in adults 80 years and older to 140 to 145 mm Hg if tolerated.1 Data from the Hypertension in the Very Elderly Trial2 and the Systolic Hypertension in the Elderly Program3 support this recommendation. The 2013 European Society of Hypertension/European Society of Cardiology guidelines for the management of hypertension recommended in patients older than 80 years with a systolic blood pressure of 160 mm Hg or higher lowering the systolic blood pressure to between 140 and 150 mm Hg, provided they are in good physical and mental condition.4 These guidelines recommended leaving decisions about antihypertensive treatment for frail elderly patients to the treating physician based on monitoring of the clinical effects of therapy.4 The 2014 guidelines report from the Eighth Joint National Committee (JNC 8) recommended lowering the blood pressure in persons 60 years and older to less than 150/90 mm Hg if they do not have diabetes mellitus or chronic kidney disease and to less than 140/90 mm Hg if they have diabetes mellitus or chronic kidney disease.5 Clinical trial data do not support lowering the blood pressure to less than 130/80 mm Hg in patients at high risk for cardiovascular events such as those with coronary artery disease or a coronary artery disease equivalent, a 10-year Framingham risk score of 10% or greater, diabetes mellitus, chronic kidney disease, or congestive heart failure with reduced left ventricular ejection fraction.6