Age related decrease in arterial compliance determines a shift in the pattern of hypertension from diastolic to systolic after middle-age. The significance of systolic and diastolic blood pressure as predictors of cardiovascular disease also changes with age so that the risk of death in older hypertensive patients is positively correlated with systolic blood pressure, whereas the association with diastolic blood pressure becomes negative. Accordingly, the target level of blood pressure to be reached by antihypertensive treatment in older patients should be based on systolic rather than on diastolic blood pressure. The goal suggested in previous guidelines (140-150mmHg) is currently considered too conservative for active and independent elderly patients. Consequently, European guideline recommend that blood pressure be reduced in elderly and very elderly hypertensive patients to 130-139/80mmHg, but not below 130mmHg, whereas the US guideline recommend a goal of <130/80mmHg. However, in older subjects the association between blood pressure and mortality varies with health and functional status. Therefore, in frail patients with low DBP, orthostatic hypotension or more severe comorbidities, antihypertensive treatment should be individualized to identify the best achievable BP according to tolerability and adverse effects.
Alfie, J., & Cuffaro, P. E. (2019). Hypertension in the elderly. In Encyclopedia of Biomedical Gerontology (pp. 258–270). Elsevier. https://doi.org/10.1016/B978-0-12-801238-3.62166-9