Clinicians should initiate treatment in patients 60 years of age or older with hypertension to reduce systolic blood pressure (BP) to less than 150 mm Hg, according to new recommendations released Jan. 16 by the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP).

Guideline authors reviewed published randomized, controlled trials and observational studies for outcomes of all-cause mortality, morbidity and mortality related to stroke, myocardial infarction, sudden cardiac death and harms. In most cases, patients in the studies had moderate or severe hypertension (systolic BP > 160 mm Hg) at baseline and reduced their systolic BP to 140 mm Hg with treatment. Based on the review, the guideline includes three recommendations related to systolic BP in older adults, including a “strong” recommendation that treatment should be initiated in patients aged 60+ with systolic BP persistently at 150 mm Hg or above in order to reach a target of 150 mm Hg or below to reduce the risk of mortality, stroke and cardiac events.

Additionally, based on moderate-quality evidence, the guideline includes a “weak” recommendation for initiating or intensifying pharmacologic treatment in patients aged 60+ with a history of stroke or transient ischemic attack, with a target systolic BP of 140 mm Hg or below to reduce the risk of recurrent stroke. A “weak” recommendation is also included for initiating or intensifying pharmacological treatment in some adults aged 60+ at high cardiovascular risk, with a target systolic BP of 140 mm Hg to reduce the risk of stroke or cardiac events. The ACP and AAFP also indicate that clinicians “select treatment goals for adults aged 60 or older based on periodic discussion of the benefits and harms of specific BP targets with the patient.”

“Attention to the management of treatment of hypertension is essential,” said ACC President Richard A. Chazal, MD, FACC. “There continues to be some debate over the optimal time to begin medication treatment, as well as treatment goals for high blood pressure, especially in patients over the age of 60. A multi-disciplinary writing panel led by the ACC and the AHA is currently finalizing a comprehensive new guideline for the management of hypertension that will  be released later this year and will update the JNC 7 guideline and provide guidance for all Americans. In addition to careful and thorough review of the latest research and science around hypertension management, the writing panel will also take into consideration these new recommendations from the ACP and AAFP, as well as those released in December 2013 by some members of the Eighth JNC Panel.”

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