Strict control [ systolic BP ( SBP ) < 140 mmHg ] was not consistently better than mild control ( SBP < 150 mmHg ) for adults aged ≥65 years .
Mild SBP control benefitted subjects in all age ranges over 65 years .
Conclusions In this review , older adults with hypertension had decreased cardiovascular morbidity and mortality  with antihypertensives compared with no treatment .
Strict control was not consistently better than mild control in older adults .
The current evidence is insufficient to determine the safest , most beneficial hypertension regimen in older adults
Background Hypertension increases with increasing age .
Optimal treatment of hypertension is important to reduce cardiovascular disease .
Recent guidelines for hypertension have made recommendations for older adults but are supported by evidence that includes younger individuals .
This systematic review evaluates the benefits and harms of antihypertensive agents in adults aged ≥65 years .
Stroke prevention with the angiotensin II type 1-receptor blocker candesartan in elderly patients with isolated systolic hypertension: the Study on Cognition and Prognosis in the Elderly (SCOPE).
OBJECTIVES The aim of this study was to test the hypothesis that the angiotensin II type 1 receptor blocker ( ARB ) c and esartan can reduce the risk of stroke in elderly patients with isolated systolic hypertension ( ISH ) . BACKGROUND Isolated systolic hypertension is the predominant form of hypertension in the elderly , and stroke is the most common cardiovascular ( CV ) complication . METHODS In the Study on Cognition and Prognosis in the Elderly ( SCOPE ) , 4,964 patients age 70 to 89 years were r and omly assigned to double-blind c and esartan or placebo with open-label antihypertensive therapy ( mostly thiazide diuretics ) added as needed to control blood pressure . Of the 4,964 patients , 1,518 had ISH ( systolic blood pressure > 160 mm Hg and diastolic blood pressure < 90 mm Hg ) . The present study is a predefined subgroup analysis of outcome results in the ISH patients . RESULTS Of the ISH patients , 754 were r and omized to the c and esartan group and 764 to the control group . Over the study period , blood pressure was reduced by 22/6 mm Hg in the c and esartan group and by 20/5 mm Hg in the control group ( difference between treatments 2/1 mm Hg ; p = 0.101 and 0.064 ) . A total of 20 fatal/non-fatal strokes occurred in the c and esartan group ( 7.2/1,000 patient-years ) and 35 in the control group ( 12.5/1,000 patient-years ) ; relative risk ( RR ) was 0.58 ( 95 % confidence interval 0.33 to 1.00 ) , that is , a RR reduction of 42 % ( p = 0.050 unadjusted , p = 0.049 adjusted for baseline risk ) . There were no marked or statistically significant differences between the treatment groups in other CV end points or all-cause mortality . CONCLUSIONS In elderly patients with ISH , antihypertensive treatment based on the ARB c and esartan result ed in a significant 42 % RR reduction in stroke in comparison with other antihypertensive treatment , despite little difference in blood pressure reduction
Strict control [ systolic BP ( SBP ) < 140 mmHg ] was not consistently better than mild control ( SBP < 150 mmHg ) for adults aged ≥65 years .
Mild SBP control benefitted subjects in all age ranges over 65 years .
Conclusions In this review , older adults with hypertension had decreased cardiovascular morbidity and mortality  with antihypertensives compared with no treatment .
Strict control was not consistently better than mild control in older adults .
The current evidence is insufficient to determine the safest , most beneficial hypertension regimen in older adults
Background Hypertension increases with increasing age .
Optimal treatment of hypertension is important to reduce cardiovascular disease .
Recent guidelines for hypertension have made recommendations for older adults but are supported by evidence that includes younger individuals .
This systematic review evaluates the benefits and harms of antihypertensive agents in adults aged ≥65 years .