The optimal blood pressure target in old and very old patients with hypertension

Ran Zhang; Ivan Chun Hang Lam; Xinyi Liu; Feng Sun; Siyan Zhan; Kai Hang Yiu; Celine Sze Ling Chui; Esther Wai Yin Chan; Ian Chi Kei Wong; Cindy Lo Kuen Lam; Eric Yuk Fai Wan

doi:10.1093/ageing/afag167

The optimal blood pressure target in old and very old patients with hypertension

Ran Zhang
, Ivan Chun Hang Lam
, Xinyi Liu
, Feng Sun
, Siyan Zhan
, Kai Hang Yiu
, Celine Sze Ling Chui
, Esther Wai Yin Chan
, Ian Chi Kei Wong
, Cindy Lo Kuen Lam
, Eric Yuk Fai Wan^*

^*Corresponding author for this work

The Chinese University of Hong Kong
University of Oxford
Peking University

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: With the rise in older population globally, the optimal blood pressure (BP) target for antihypertensive therapy in those aged 60 and above remains to be evaluated in the real-world practice. This study evaluated the effectiveness and safety of standard versus lower BP targets in old (aged 60–79) and very old (aged ≥80) patients with hypertension in real-world clinical settings.

Methods: We emulated a target trial using electronic medical records from the Hong Kong Hospital Authority, including patients aged 60 years or above with a diagnosis of hypertension, uncontrolled BP and records of antihypertensives adjustments from 2008 to 2013. Patients were first categorized into 3 age groups (60–69, 70–79, ≥ 80) and then assigned to BP targets of either 130–140/80–90 mmHg or below 130/80 mmHg. Outcomes included major cardiovascular disease (CVD), end-stage renal disease, all-cause mortality and major adverse events related to antihypertensive treatment.

Results: Of 132 430 eligible patients identified, 52 553, 28 661 and 7106 patients aged 60–69, 70–79 and ≥ 80 years had BP targets of 130–140/80–90 mmHg, respectively; 11 148, 5636 and 1203 of patients in the same age groups had targets below 130/80 mmHg. Lower BP target was associated with reduced overall CVD and all-cause mortality: aged 60–69 years (CVD HR: 0.91 [95% CI, 0.85–0.96]; all-cause mortality: 0.89 [0.81–0.98]), aged 70–79 years (CVD: 0.87 [0.82–0.93]; all-cause mortality: 0.84 [0.78–0.91]), and aged≥80 years (CVD: 0.77 [0.69–0.86]; all-cause mortality: 0.80 [0.72–0.89]). No significant increase in major adverse events was observed in any age group. Results were consistent across all subgroups.

Conclusion: Lowering BP of below 130/80 mmHg in old and very old patients was associated with better cardiovascular and mortality outcomes without increased adverse events. These findings suggest that a lower BP target may be beneficial and safe for older patients with hypertension.

Original language	English
Article number	afag167
Number of pages	12
Journal	Age and Ageing
Volume	55
Issue number	6
Early online date	8 Jun 2026
DOIs	https://doi.org/10.1093/ageing/afag167
Publication status	Published - 8 Jun 2026

Bibliographical note

Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Funding

We would like to thank the Central Panel on Administrative Assessment of External Data Requests of the Hospital Authority for approval of the data extraction for our study. The data analysis was performed using research computing facilities provided by Information Technology Service, The University of Hong Kong. We would like to thank them for their ongoing support of this project. This study was supported by Health Bureau, the Government of Hong Kong Special Administrative Region, China [No. 18192571].

Funders	Funder number
University of Hong Kong
18192571

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

blood pressure
older patients
hypertension
antihypertension management

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10.1093/ageing/afag167Licence: CC BY-NC-ND 4.0

The optimal blood pressure target in old and very old patients with hypertension
Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Final published version, 1.68 MBLicence: CC BY-NC-ND 4.0

Cite this

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title = "The optimal blood pressure target in old and very old patients with hypertension",

abstract = "Background: With the rise in older population globally, the optimal blood pressure (BP) target for antihypertensive therapy in those aged 60 and above remains to be evaluated in the real-world practice. This study evaluated the effectiveness and safety of standard versus lower BP targets in old (aged 60–79) and very old (aged ≥80) patients with hypertension in real-world clinical settings. Methods: We emulated a target trial using electronic medical records from the Hong Kong Hospital Authority, including patients aged 60 years or above with a diagnosis of hypertension, uncontrolled BP and records of antihypertensives adjustments from 2008 to 2013. Patients were first categorized into 3 age groups (60–69, 70–79, ≥ 80) and then assigned to BP targets of either 130–140/80–90 mmHg or below 130/80 mmHg. Outcomes included major cardiovascular disease (CVD), end-stage renal disease, all-cause mortality and major adverse events related to antihypertensive treatment. Results: Of 132 430 eligible patients identified, 52 553, 28 661 and 7106 patients aged 60–69, 70–79 and ≥ 80 years had BP targets of 130–140/80–90 mmHg, respectively; 11 148, 5636 and 1203 of patients in the same age groups had targets below 130/80 mmHg. Lower BP target was associated with reduced overall CVD and all-cause mortality: aged 60–69 years (CVD HR: 0.91 [95\% CI, 0.85–0.96]; all-cause mortality: 0.89 [0.81–0.98]), aged 70–79 years (CVD: 0.87 [0.82–0.93]; all-cause mortality: 0.84 [0.78–0.91]), and aged≥80 years (CVD: 0.77 [0.69–0.86]; all-cause mortality: 0.80 [0.72–0.89]). No significant increase in major adverse events was observed in any age group. Results were consistent across all subgroups. Conclusion: Lowering BP of below 130/80 mmHg in old and very old patients was associated with better cardiovascular and mortality outcomes without increased adverse events. These findings suggest that a lower BP target may be beneficial and safe for older patients with hypertension.",

keywords = "blood pressure, older patients, hypertension, antihypertension management",

author = "Ran Zhang and Lam, \{Ivan Chun Hang\} and Xinyi Liu and Feng Sun and Siyan Zhan and Yiu, \{Kai Hang\} and Chui, \{Celine Sze Ling\} and Chan, \{Esther Wai Yin\} and Wong, \{Ian Chi Kei\} and Lam, \{Cindy Lo Kuen\} and Wan, \{Eric Yuk Fai\}",

note = "Copyright {\textcopyright} The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/).",

year = "2026",

month = jun,

day = "8",

doi = "10.1093/ageing/afag167",

language = "English",

volume = "55",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

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T1 - The optimal blood pressure target in old and very old patients with hypertension

AU - Zhang, Ran

AU - Lam, Ivan Chun Hang

AU - Liu, Xinyi

AU - Sun, Feng

AU - Zhan, Siyan

AU - Yiu, Kai Hang

AU - Chui, Celine Sze Ling

AU - Chan, Esther Wai Yin

AU - Wong, Ian Chi Kei

AU - Lam, Cindy Lo Kuen

AU - Wan, Eric Yuk Fai

N1 - Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/).

PY - 2026/6/8

Y1 - 2026/6/8

N2 - Background: With the rise in older population globally, the optimal blood pressure (BP) target for antihypertensive therapy in those aged 60 and above remains to be evaluated in the real-world practice. This study evaluated the effectiveness and safety of standard versus lower BP targets in old (aged 60–79) and very old (aged ≥80) patients with hypertension in real-world clinical settings. Methods: We emulated a target trial using electronic medical records from the Hong Kong Hospital Authority, including patients aged 60 years or above with a diagnosis of hypertension, uncontrolled BP and records of antihypertensives adjustments from 2008 to 2013. Patients were first categorized into 3 age groups (60–69, 70–79, ≥ 80) and then assigned to BP targets of either 130–140/80–90 mmHg or below 130/80 mmHg. Outcomes included major cardiovascular disease (CVD), end-stage renal disease, all-cause mortality and major adverse events related to antihypertensive treatment. Results: Of 132 430 eligible patients identified, 52 553, 28 661 and 7106 patients aged 60–69, 70–79 and ≥ 80 years had BP targets of 130–140/80–90 mmHg, respectively; 11 148, 5636 and 1203 of patients in the same age groups had targets below 130/80 mmHg. Lower BP target was associated with reduced overall CVD and all-cause mortality: aged 60–69 years (CVD HR: 0.91 [95% CI, 0.85–0.96]; all-cause mortality: 0.89 [0.81–0.98]), aged 70–79 years (CVD: 0.87 [0.82–0.93]; all-cause mortality: 0.84 [0.78–0.91]), and aged≥80 years (CVD: 0.77 [0.69–0.86]; all-cause mortality: 0.80 [0.72–0.89]). No significant increase in major adverse events was observed in any age group. Results were consistent across all subgroups. Conclusion: Lowering BP of below 130/80 mmHg in old and very old patients was associated with better cardiovascular and mortality outcomes without increased adverse events. These findings suggest that a lower BP target may be beneficial and safe for older patients with hypertension.

AB - Background: With the rise in older population globally, the optimal blood pressure (BP) target for antihypertensive therapy in those aged 60 and above remains to be evaluated in the real-world practice. This study evaluated the effectiveness and safety of standard versus lower BP targets in old (aged 60–79) and very old (aged ≥80) patients with hypertension in real-world clinical settings. Methods: We emulated a target trial using electronic medical records from the Hong Kong Hospital Authority, including patients aged 60 years or above with a diagnosis of hypertension, uncontrolled BP and records of antihypertensives adjustments from 2008 to 2013. Patients were first categorized into 3 age groups (60–69, 70–79, ≥ 80) and then assigned to BP targets of either 130–140/80–90 mmHg or below 130/80 mmHg. Outcomes included major cardiovascular disease (CVD), end-stage renal disease, all-cause mortality and major adverse events related to antihypertensive treatment. Results: Of 132 430 eligible patients identified, 52 553, 28 661 and 7106 patients aged 60–69, 70–79 and ≥ 80 years had BP targets of 130–140/80–90 mmHg, respectively; 11 148, 5636 and 1203 of patients in the same age groups had targets below 130/80 mmHg. Lower BP target was associated with reduced overall CVD and all-cause mortality: aged 60–69 years (CVD HR: 0.91 [95% CI, 0.85–0.96]; all-cause mortality: 0.89 [0.81–0.98]), aged 70–79 years (CVD: 0.87 [0.82–0.93]; all-cause mortality: 0.84 [0.78–0.91]), and aged≥80 years (CVD: 0.77 [0.69–0.86]; all-cause mortality: 0.80 [0.72–0.89]). No significant increase in major adverse events was observed in any age group. Results were consistent across all subgroups. Conclusion: Lowering BP of below 130/80 mmHg in old and very old patients was associated with better cardiovascular and mortality outcomes without increased adverse events. These findings suggest that a lower BP target may be beneficial and safe for older patients with hypertension.

KW - blood pressure

KW - older patients

KW - hypertension

KW - antihypertension management

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U2 - 10.1093/ageing/afag167

DO - 10.1093/ageing/afag167

M3 - Article

SN - 0002-0729

VL - 55

JO - Age and Ageing

JF - Age and Ageing

IS - 6

M1 - afag167

ER -

The optimal blood pressure target in old and very old patients with hypertension

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

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