title: Threshold and Target for Blood Pressure Lowering in the Elderly.
abstract: OBJECTIVE
  Detection of elevated blood pressure values in elderly patients represents a common clinical condition associated with an increased cardiovascular risk. This has been shown to be the case in both systodiastolic and isolated systolic hypertension as well. However, despite the evidence of the benefits of the blood pressure lowering intervention in terms of reduction of cardiovascular morbidity and mortality, at least two issues related to antihypertensive drug treatment in aged individuals are still undefined: (1) the blood pressure threshold at which antihypertensive drug should be initiated and (2) the blood pressure goals of the therapeutic intervention.
  
  
  RESULTS
  The present paper will critically review the evidence available so far on these two issues as well as the position of current guidelines and consensus statements. Emphasis will be given to the analysis of the new data of the Systolic Blood Pressure Interventional Trial (SPRINT), which have recently demonstrated the benefits, even in individuals aged more than 75 years, of a tight blood pressure reduction to systolic blood pressure to 120 mmHg or less. The potential limitations of the trial will be also critically addressed and the expectations of ongoing clinical studies investigating the issue in elderly patients properly emphasized. Although of interest, the results of the SPRINT trial encompass a number of limitations which limit their applicability to the general elderly hypertensive population. A prudent approach will be to adopt in clinical practice the less intensive and more conservative targets recommended by current guidelines.
authors: Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. guido.grassi@unimib.it.|IRCCS Multimedica, Sesto San Giovanni, Milan, Italy. guido.grassi@unimib.it.
authors: Guido
authors: G
authors: Grassi
authors: Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
authors: Fosca
authors: F
authors: Quarti-Trevano
authors: Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
authors: Anna
authors: A
authors: Casati
authors: Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
authors: Raffaella
authors: R
authors: Dell'Oro
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents
keywords: Antihypertensive drug treatment; Cardiovascular risk; Clinical trials; Elderly; Guidelines; Hypertension; Target blood pressure