High Blood Pressure

Although the benefit of treating hypertension in elderly subjects is now well established, controversy still exists regarding the goal blood pressure. Indeed, according to the J curve hypothesis, a major reduction in diastolic blood pressure to less than 65 mmHg might jeopardize appropriate blood flow in the brain, heart, and kidneys during the diastole, and might be associated with an increase in mortality. However, in the SHEP study low diastolic blood pressure did not increase mortality.

As an intermediate goal, most studies recommended either reducing systolic blood pressure to under 160 mmHg and diastolic pressure to under 90 mmHg, or reducing the initial systolic and diastolic blood pressures by 20 mmHg. The benefit of a larger decrease (≤140 mmHg) remains to be determined by the results of ongoing studies.