Lowering BP to below 130/80 mmHg in old and very old patients was associated with better cardiovascular and mortality outcomes without increased adverse events, suggesting that a lower BP target may be beneficial and safe for older patients with hypertension.
Key Findings
Results
In patients aged 60-69 years, a lower BP target (below 130/80 mmHg) was associated with reduced overall CVD and all-cause mortality compared to a standard target (130-140/80-90 mmHg).
CVD HR: 0.91 (95% CI, 0.85-0.96)
All-cause mortality HR: 0.89 (95% CI, 0.81-0.98)
52,553 patients in the standard target group and 11,148 patients in the lower target group in this age stratum
Analysis used a target trial emulation framework with electronic medical records from the Hong Kong Hospital Authority
Results
In patients aged 70-79 years, a lower BP target was associated with reduced overall CVD and all-cause mortality.
CVD HR: 0.87 (95% CI, 0.82-0.93)
All-cause mortality HR: 0.84 (95% CI, 0.78-0.91)
28,661 patients in the standard target group and 5,636 patients in the lower target group in this age stratum
Results were described as consistent across all subgroups
Results
In patients aged 80 years or above (very old), a lower BP target was associated with the largest relative reductions in CVD and all-cause mortality among all age groups.
CVD HR: 0.77 (95% CI, 0.69-0.86)
All-cause mortality HR: 0.80 (95% CI, 0.72-0.89)
7,106 patients in the standard target group and 1,203 patients in the lower target group in this age stratum
The magnitude of benefit appeared numerically greater in the very old group compared to younger age strata
Results
No significant increase in major adverse events related to antihypertensive treatment was observed in any age group when targeting BP below 130/80 mmHg.
Outcomes assessed included major adverse events related to antihypertensive treatment across all three age groups (60-69, 70-79, and ≥80 years)
Results were consistent across all subgroups examined
This finding addresses safety concerns often raised about intensive BP lowering in older patients
Methods
The study emulated a target trial using real-world electronic medical records from the Hong Kong Hospital Authority, including patients aged 60 or above with hypertension, uncontrolled BP, and records of antihypertensive adjustments from 2008 to 2013.
132,430 eligible patients were identified in total
Patients were categorized into three age groups: 60-69, 70-79, and ≥80 years
BP targets compared were 130-140/80-90 mmHg (standard) versus below 130/80 mmHg (lower)
Outcomes included major CVD, end-stage renal disease, all-cause mortality, and major adverse events related to antihypertensive treatment
What This Means
This research suggests that for older adults with high blood pressure — including those aged 80 and above — targeting a lower blood pressure goal (below 130/80 mmHg) is associated with better health outcomes than a more moderate target (130-140/80-90 mmHg). Using health records from over 132,000 patients in Hong Kong, the researchers found that patients in all three age groups studied (60-69, 70-79, and 80+) who achieved the lower blood pressure target had fewer major cardiovascular events and lower rates of death from any cause. Notably, the very oldest patients (aged 80 and above) appeared to show the largest relative benefit, with a 23% lower risk of cardiovascular disease and a 20% lower risk of death.
A key concern with lowering blood pressure aggressively in older patients has been the risk of harmful side effects, such as falls, dizziness, or kidney problems. This study found no significant increase in such adverse events in any age group when the lower target was used, suggesting the approach was safe in this real-world population. These findings are notable because they come from routine clinical practice rather than a controlled clinical trial, making them relevant to the broader, more complex population of older adults typically seen in everyday healthcare settings.
This research suggests that current clinical guidelines recommending more cautious blood pressure targets for older and very old patients may warrant reconsideration. The results support the potential benefits of aiming for below 130/80 mmHg even in patients aged 80 and older, though individual patient circumstances and clinical judgment remain important factors in treatment decisions.
Zhang R, Lam I, Liu X, Sun F, Zhan S, Yiu K, et al.. (2026). The optimal blood pressure target in old and very old patients with hypertension.. Age and ageing. https://doi.org/10.1093/ageing/afag167