Skip to main content

Table 6 Recommendations for older adults from recent international guidelines on screening for and treatment of hypertension

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
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
  1. ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure; CVD, cardiovascular disease; NICE 2011, UK National Institute for Health and Care Excellence Guidelines 2011 [6]; JNC 8 2014, the Eighth Joint National Committee Guidelines 2014 [7]; ESH/ESC 2013, European Society of Hypertension and the European Society of Cardiology Guidelines 2013 [8]; ACC/AHA 2017, American College of Cardiology and American Heart Association Guideline 2017 [15]; USPSTF 2015, US Preventive Services Task Force Guidelines 2015 [9]