From: Screening and treatment of hypertension in older adults: less is more?
 | NICE, 2011 | ESH/ESC, 2013 | JNC 8, 2014 | USPSTF, 2015 | ACC/AHA, 2017 |
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Measurement and screening | If normal BP: screening every 5 years; if BP close to 140/90 mmHg: screening more frequently ABPM or HBPM for monitoring treatment effect No specific recommendations for older adults | No mention of screening Out-of-office BP is recommended to search for orthostatic hypotension, especially for older adults, and for white coat and masked hypertension | No recommendations about measurement or screening | If 18–39 years with normal BP (< 130/85 mmHg) without other risk factors: screening every 3 to 5 years; if ≥ 40 years or at increased risk for high BP: annual screening No specific recommendations for older adults | No mention of screening Out-of-office BP is recommended to adapt BP-lowering medication and to screen for white coat and masked hypertension |
Target BP and/or treatment | Under 80 years: 140/90 mmHg; 80 years and more: 150/90 mmHg 80 years and more: same drug regimen than for people aged 55–80 years, accounting for comorbidities | In older adults <  80 years with SBP ≥ 160 mmHg: 140–150 mmHg • If fit: SBP < 140 mmHg may be considered • If fragile: adapting to individual tolerability In older adults >  80 years with SBP ≥ 160 mmHg: • If in good physical and mental conditions: SBP 140–150 mmHg (may be set high if no history of CVD) • Frail: leave decisions to the treating physician, based on monitoring of the clinical effects of treatment | 30–59 years: 140/90 mmHg; 60 years and more: 150/90 mmHg (some experts recommend 140 mmHg). No need to adapt treatment if SBP is lower than 140 mmHg and if there are no adverse effects on health or on quality of life No specific recommendations for older adults | Younger adults: 140/90 mmHg; 60 years and more: 150/90 mmHg (according to some expert opinion: 140/90 mmHg) No specific recommendations for older adults | Same treatment targets than in younger adults (130/80 mmHg) with close monitoring of BP and treatment effect in case of comorbidity NB. For the primary prevention of CVD, treatment is recommended in adults with an estimated 10-year ASCVD risk of ≥ 10% and SBP ≥ 130/80 mmHg. Hence, because the majority of older adults have a 10-year ASCVD risk ≥ 10% and have BP ≥ 130/80 mmHg, a treatment is recommended |