At what blood pressure level should antihypertensive medication be given and what is the treatment goal?
In the year 2000, an advisory statement on systolic blood pressure in the elderly15 was issued to complement the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 6; 1997). The statement rejected the concept of age-adjusted blood pressure targets, adopting 140/90 as the goal blood pressure (130/85 in diabetics) for elderly hypertensive subjects, including those with ISH. These guidelines were the same as those recommended by JNC 6 for adults in general, although in the case of ISH the evidence base was derived from two treatment trials (SHEP16 and SYST-EUR)17 in which the lower limit for subject entry was 160/90. Since the time of publication of the advisory statement, further evidence from a large controlled trial (ALLHAT)18 has supported the 140 mm Hg goal for systolic blood pressure in ISH.