Blood pressure targets, medication considerations and special concerns in elderly hypertension: Focus on atherosclerotic cardiovascular diseases, atrial fibrillation, heart failure, and aortic stenosis

The management of hypertension in the elderly, particularly concerning atherosclerotic cardiovascular disease (ASCVD) and comorbidities, is crucial given its prevalence and impact on morbidity and mortality. It is important to individualize pharmacotherapy in elderly patients, including basing the dose on age-related changes in organ function and drug pharmacokinetics. In elderly patients with hypertension and ASCVD, despite slight differences among guideline recommendations, the emphasis is on achieving a systolic blood pressure (BP) < 130 mmHg. The optimal target for patients with atrial fibrillation remains under debate, with suggestions ranging from <130/80 mmHg to <140/90 mmHg. The role of anticoagulation treatment further complicates BP management in these patients. BP targets also differ among guidelines regarding heart failure in the elderly, although maintaining systolic BP < 140/90 mmHg is generally advocated. In hypertensive elderly patients with aortic stenosis, the optimal BP targets are even less clear, and should consider the risks of adverse outcomes. Overall, individualized treatment plans considering age, comorbidities, and tolerability are paramount. Further research is warranted to elucidate optimal BP targets and pharmacotherapeutic strategies tailored to the elderly.