Hypertension is tough to manage in the elderly as no one really knows what the target blood pressures should be in the age >80. The standard guidelines might not really be correct in the very elderly population.
Perhaps a slightly higher blood pressure might be more prudent in the very elderly. Prior studies have shown increase mortality in over management of HTN in the elderly.
A recent study has an interesting way to look at HTN. Using walking speeds to assess the risk of HTN management in the elderly is a novel concept. The
association between BP and mortality varied by walking speed. The fast walkers(≥0.8 m/s for a 20ft walk) with with elevated systolic BP (≥140 mm Hg) had a greater adjusted
risk of mortality compared with those without. Among slower walkers, neither elevated systolic nor diastolic BP
(≥90 mm Hg) was associated with mortality. Interestingly, they also found elevated systolic
and diastolic BP was strongly and independently associated with a lower mortality in people who didn't complete the walking test. These findings are
consistent with prior studies that have found that the association of BP and mortality diminishes with age. HTN management might change as frailty increases with age.
Testing walking speeds for the hypertension management and assessing risk might be an easy tool to use.
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