Hypertension Management in Elderly Patients

Initial Assessment and Treatment

• The American Heart Association recommends using validated automated upper arm cuff devices with appropriate cuff size to measure blood pressure in elderly patients 1
• The European Society of Cardiology suggests measuring blood pressure in both arms at the first visit and using the arm with the higher blood pressure for subsequent measurements 2
• The American College of Cardiology recommends confirming hypertension with home or ambulatory blood pressure monitoring if office blood pressure is ≥130/85 mmHg 2

First-Line Pharmacological Treatment

• The European Society of Hypertension recommends starting with low-dose thiazide diuretics (e.g., hydrochlorothiazide 12.5 mg/day) as the first-line treatment for non-black elderly patients 1, 4
• The American Heart Association suggests starting with low-dose ARB or a combination of ARB + DHP-CCB or DHP-CCB + thiazide diuretic for black elderly patients 1, 2

Special Considerations for Elderly Patients

• The European Society of Cardiology recommends gradual initial doses and subsequent titration due to the greater risk of adverse effects in elderly patients 4
• The American College of Cardiology suggests aiming to reduce blood pressure by at least 20/10 mmHg, ideally to <140/90 mmHg, but individualizing based on frailty 2, 4
• The European Society of Hypertension recommends considering monotherapy in patients aged >80 years or frail 2

Monitoring and Follow-up

• The American Heart Association recommends aiming to achieve target blood pressure within 3 months 2
• The European Society of Cardiology suggests checking adherence regularly and monitoring for orthostatic hypotension, especially when initiating or increasing doses 2, 4