Key highlights of the 2026 Taiwan Hypertension Society guidelines for the management of hypertension in older adults

Taiwan, in common with other high-income East Asian societies, is experiencing rapid demographic aging. Hypertension is present in the majority of older adults and remains the leading modifiable determinant of cardiovascular morbidity and mortality in this population. Yet managing blood pressure (BP) in older adults differs qualitatively from managing it in younger patients: arterial stiffening, salt sensitivity, orthostatic BP dysregulation, atrial fibrillation, frailty, cognitive vulnerability, and multimorbidity collectively alter the benefit-harm balance in ways that conventional guidelines-designed predominantly around middle-aged trial populations-do not adequately capture. To address this gap, the Taiwan Hypertension Society (THS) published the 2026 Guidelines for the Management of Hypertension in Older Adults, endorsed by the Taiwan Society of Cardiology (TSOC), the Taiwan Association of Gerontology and Geriatrics (TAGG), and the Taiwan Society of Family Medicine (TSFM). The guideline comprises 63 actionable recommendations developed through PICO-formulated clinical questions, systematic evidence appraisal, and the GRADE approach, with structured expert consensus for areas of limited evidence. Key updates include a measurement-first framework centered on validated oscillometric devices and the 7-2-2 home BP monitoring (HBPM) protocol; age- and comorbidity-stratified systolic BP (SBP) targets with frailty-sensitive safeguards; structured lifestyle prescriptions packaged as the SP-ABCDE mnemonic; individualized pharmacological management with explicit deprescribing considerations; and dedicated sections on orthostatic hypotension, atrial fibrillation, cognitive impairment, and resistant hypertension. This article summarizes the major highlights and clinical implications of the 2026 THS Hypertension guideline for older adults. Key components of the 2026 Taiwan Hypertension Society (THS) Guidelines for the Management of Hypertension in Older Adults. The upper panels summarize the diagnostic and lifestyle foundations-including the 7-2-2 home blood pressure monitoring (HBPM) protocol and the SP-ABCDE lifestyle prescription-together with the age- and risk-stratified systolic blood pressure (SBP) targets. For the intensive-versus-standard target comparison, an SBP target of <130 mmHg is a Strong recommendation for general older adults aged 65-79 years but a Conditional recommendation for those aged ≥80 years; a more intensive target of <120 mmHg may be considered (Conditional recommendation) in high-risk older adults with two or more additional cardiovascular risk factors. The lower panels summarize precision targets and frailty safeguards-including individualized targets and deprescribing considerations in frail older adults-and emphasize accurate BP measurement as a patient-safety strategy, including screening for orthostatic hypotension to prevent falls and syncope. HBPM home blood pressure monitoring, OH orthostatic hypotension SBP systolic blood pressure.