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 .
Combination therapy for hypertension in the elderly: a sub-analysis of the Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) Trial
The Combination Therapy of Hypertension to Prevent Cardiovascular Events ( COPE ) trial demonstrated that the calcium-channel blocker benidipine-based combination therapies with an angiotensin-receptor blocker ( ARB ) , a β-blocker , or a thiazide diuretic ( thiazide ) were similarly effective in preventing cardiovascular events and achieving the target blood pressure ( BP ; < 140/90 mm Hg ) . We further evaluated the efficacy and safety of these combination therapies in older ( ⩾65 years ) and younger ( < 65 years ) hypertensive patients . In this sub- analysis of the COPE trial 3293 patients ( 1533⩾65 years old and 1760 < 65 years old ) were r and omly assigned to receive benidipine-based therapy with an ARB , a β-blocker or a thiazide . In each group , the average BP did not differ among the three treatment groups . The incidence of the primary cardiovascular composite end point in the older group was higher than in the younger group ( 12.7 vs. 8.3 per 1000 person-years , P=0.023 ) . The primary composite cardiovascular end point , achievement ( % ) of target BP , and cardiovascular hard composite end points were similar among the three treatment groups . However , the hazard ratios and 95 % confidence intervals in older patients were 2.74 ( 1.08–6.96 ; β-blocker vs. thiazide , P=0.022 ) for fatal and non-fatal stroke , and 2.47 ( 1.03–5.91 ; β-blocker vs. ARB , P=0.043 ) for new-onset diabetes . Thus , benidipine combined with an ARB , a β-blocker , or a thiazide was similarly effective in preventing cardiovascular events and achieving the target BP in both older and younger hypertensive patients . Further studies will be necessary to evaluate the usefulness of benidipine combined with a β-blocker in terms of the incidence of stroke and new-onset diabetes in older patients
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 .