CTF Summary Table: Hypertension in the Elderly

Canadian Task Force on Preventive Health Care

Summary Table of Recommendations

Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.

Hypertension in the Elderly: Case-Finding and Treatment to Prevent Vascular Disease

Prepared by Christopher Patterson, MD, FRCPC, Professor and Head, Division of Geriatric Medicine, McMaster University, Hamilton, Ontario, and Alexander G. Logan, MD, FRCPC, Professor of Medicine, University of Toronto

These recommendations were finalized by the Task Force in January 1994

MANEUVER EFFECTIVENESS LEVEL OF EVIDENCE <REF> RECOMMENDATION

Measurement of blood pressure (BP) level used to identify hypertensive individuals. Average of at least two readings on each of at least three occasions over a period of six months. Although not evaluated for its effectiveness, case-finding should be considered in all persons aged 65 to 84 years; individual clinical judgement should be exercised in all other areas. Expert opinion* <11> (III) Fair evidence to include in the periodic health examination (PHE). (B)

Pharmacologic treatment of hypertension. Therapy for hypertension should be individualized, based on age, type and level of blood pressure elevation.

a) In persons up to 70 years with diastolic BP of 90 mmHg or over treatment lowers risk of stroke, cardiac events and death. Randomized controlled trial <2> (I) Good evidence to treat. (A)

b) In persons aged 70 to 84 years with diastolic BP of 90 mmHg or over and systolic BP of 160 mmHg or over treatment lowers risk of stroke and death. Randomized controlled trial <4,5,8,9> (I) Good evidence to treat. (A)

c) In persons aged 60 to 84 years with systolic BP of 160 mmHg or over with diastolic BP less than 90 mmHg - treatment lowers risk of stroke. Randomized controlled trial <7> (I) Good evidence to treat. (A)

d) In person over 84 years of age with elevated systolic or diastolic BP there is no evidence of benefit. Cautious and individualized approach is recommended. Expert opinion <15> (III) Insufficient evidence to include or exclude (C); cautious and individualized approach recommended.

e) In persons aged 65 to 84 years with systolic BP of 140 to 160 mmHg and diastolic BP less than 90 mmHg, there is no evidence of benefit to treatment. Expert opinion <15> (III) Insufficient evidence to include in or exclude from PHE. (C)

f) In persons over 70 years of age with diastolic BP 90 mmHg or over and systolic BP less than 160 mmHg, there is no evidence of benefit to treatment. Expert opinion <15> (III) Insufficient evidence to include in or exclude from PHE. (C)

* High prevalence, effective detection maneuver and efficacious treatment.

Link to Full Text of this review

Link to Structured Abstract of this review

Link to Selected References list of this review

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MANEUVER	EFFECTIVENESS	LEVEL OF EVIDENCE <REF>	RECOMMENDATION
Measurement of blood pressure (BP) level used to identify hypertensive individuals.	Average of at least two readings on each of at least three occasions over a period of six months. Although not evaluated for its effectiveness, case-finding should be considered in all persons aged 65 to 84 years; individual clinical judgement should be exercised in all other areas.	Expert opinion* <11> (III)	Fair evidence to include in the periodic health examination (PHE). (B)
Pharmacologic treatment of hypertension.	Therapy for hypertension should be individualized, based on age, type and level of blood pressure elevation.
	a) In persons up to 70 years with diastolic BP of 90 mmHg or over treatment lowers risk of stroke, cardiac events and death.	Randomized controlled trial <2> (I)	Good evidence to treat. (A)
	b) In persons aged 70 to 84 years with diastolic BP of 90 mmHg or over and systolic BP of 160 mmHg or over treatment lowers risk of stroke and death.	Randomized controlled trial <4,5,8,9> (I)	Good evidence to treat. (A)
	c) In persons aged 60 to 84 years with systolic BP of 160 mmHg or over with diastolic BP less than 90 mmHg - treatment lowers risk of stroke.	Randomized controlled trial <7> (I)	Good evidence to treat. (A)
	d) In person over 84 years of age with elevated systolic or diastolic BP there is no evidence of benefit. Cautious and individualized approach is recommended.	Expert opinion <15> (III)	Insufficient evidence to include or exclude (C); cautious and individualized approach recommended.
	e) In persons aged 65 to 84 years with systolic BP of 140 to 160 mmHg and diastolic BP less than 90 mmHg, there is no evidence of benefit to treatment.	Expert opinion <15> (III)	Insufficient evidence to include in or exclude from PHE. (C)
	f) In persons over 70 years of age with diastolic BP 90 mmHg or over and systolic BP less than 160 mmHg, there is no evidence of benefit to treatment.	Expert opinion <15> (III)	Insufficient evidence to include in or exclude from PHE. (C)