However , the 95 % confidence intervals of these outcomes suggest the lower BP target is probably not worse , and might offer a clinical ly important benefit .
AUTHORS ' CONCLUSIONS At the present time there is insufficient evidence to know whether a higher BP target ( less than150 to 160/95 to 105 mmHg ) or a lower BP target ( less than 140/90 mmHg ) is better for older adults with high BP .
BACKGROUND Eight out of 10 major antihypertensive trials in older adults attempted to achieve a target systolic blood pressure ( BP ) less than 160 mmHg .
Collectively these trials demonstrated benefit for treatment , as compared to no treatment , for an older adult with BP greater than 160 mmHg .
However an even lower BP target of less than 140 mmHg is commonly applied to all age groups .
At the present time it is not known whether a lower or higher BP target is associated with better cardiovascular outcomes in older adults .
OBJECTIVES To assess the effects of a higher ( less than 150 to 160/95 to 105 mmHg ) BP target compared to the lower BP target of less than 140/90 mmHg in hypertensive adults 65 years of age or older .
Candesartan and cognitive decline in older patients with hypertension
Background : Hypertension is associated with impaired cognitive function but the effect of antihypertensive treatment on cognitive function is unclear . Methods : We investigated the effect of treatment of hypertension on cognition with the angiotensin-receptor-blocker , c and esartan , in a placebo-controlled , double-blind , r and omized controlled trial at one center participating in the Study on Cognition and Prognosis in the Elderly . A total of 257 older adults with hypertension ( mean age 76 years , blood pressure 165 ± 8/88 ± 7 mm Hg ) were recruited from general practice and treated with 8–16 mg c and esartan or placebo once daily , for a mean follow-up period of 44 months . Additional antihypertensive therapy was permitted in both groups to achieve treatment targets . Cognitive function was measured using the Cognitive Drug Research computerized assessment battery , trail-making tests , and verbal fluency . Data from annual assessment s were used to calculate individual coefficients of decline by regressing composite test scores over time for five cognitive domains . Results : The blood pressure difference between groups at study close was 8/3 mm Hg . The c and esartan group showed less decline in attention ( 0.004 vs −0.036 , p = 0.04 ) and episodic memory ( 0.14 vs −0.22 , p = 0.04 ) compared to placebo , a similar trend for speed of cognition ( −2.3 vs −17.4 , p = 0.15 ) , but no differences in working memory ( 0.0014 vs 0.0010 , p = 0.90 ) or executive function ( −0.0031 vs −0.0023 , p = 0.95 ) . Effect sizes were in the small-to-moderate range . Conclusions : The potential for blood pressure – lowering with angiotensin-receptor-blockers to reduce the rate of decline of specific areas of cognitive function in older patients with hypertension warrants further investigation to determine clinical efficacy
However , the 95 % confidence intervals of these outcomes suggest the lower BP target is probably not worse , and might offer a clinical ly important benefit .
AUTHORS ' CONCLUSIONS At the present time there is insufficient evidence to know whether a higher BP target ( less than150 to 160/95 to 105 mmHg ) or a lower BP target ( less than 140/90 mmHg ) is better for older adults with high BP .
BACKGROUND Eight out of 10 major antihypertensive trials in older adults attempted to achieve a target systolic blood pressure ( BP ) less than 160 mmHg .
Collectively these trials demonstrated benefit for treatment , as compared to no treatment , for an older adult with BP greater than 160 mmHg .
However an even lower BP target of less than 140 mmHg is commonly applied to all age groups .
At the present time it is not known whether a lower or higher BP target is associated with better cardiovascular outcomes in older adults .
OBJECTIVES To assess the effects of a higher ( less than 150 to 160/95 to 105 mmHg ) BP target compared to the lower BP target of less than 140/90 mmHg in hypertensive adults 65 years of age or older .