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 .
Most hospitalized older persons do not meet the enrollment criteria for clinical trials in heart failure.
BACKGROUND Although it is widely accepted that clinical trials in heart failure may not apply to older population s , the magnitude of the discrepancy between trial population s and patients seen in community-based practice are not known . Our objective was to determine the proportion of older persons meeting enrollment criteria of r and omized controlled trials of agents that prolong  life in heart failure . METHODS We conducted a cross-sectional study of Medicare beneficiaries > 64 years old with the principal diagnosis of heart failure who were discharged from acute care hospitals in the United States between April 1998 and March 1999 . Enrollment criteria of the Studies of Left Ventricular Dysfunction ( SOLVD ) , Metroprolol CR/LX R and omized Intervention Trial in Congestive Heart Failure ( MERIT-HF ) , and R and omized Aldactone Evaluation Study ( RALES ) trials were applied to the population , and the proportions meeting the criteria were determined by subgroups of age and sex . RESULTS Of the 20,388 patients studied , 18 % , 13 % , and 25 % met the enrollment criteria of the SOLVD , MERIT-HF , and RALES trials , respectively . Although trial eligibility was less than a third for any sex or age group , significantly fewer women than men met trial criteria ( 13 % vs 23 % for SOLVD , 11 % vs 17 % for MERIT-HF , and 21 % vs 32 % for RALES , P < .0001 for all ) . The oldest patients were also less likely to fulfill enrollment criteria . The proportion of all patients not included because of preserved left ventricular systolic function was twice as large as the proportion meeting the inclusion criteria for any trial . CONCLUSIONS A minority of hospitalized older persons with heart failure fit the profile of population s of clinical trials . There is an urgent need for research in heart failure for typical heart failure patients , including the very old , women , and patients with preserved left ventricular systolic function
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 .