Hypertension

PCP submission

90 yr old female with CKD3a, PAD, and HLD who presents with slightly elevated bp. should I initiate a antihypertensive given her age?

Could you please provide medication recommendations to optimize this patient’s care?

Specialist response

Thank you for this consult on a 92-year-old woman systolic blood pressure of 154, who is relatively healthy and it’s only taking eyedrops for glaucoma. I note she has CKD 3a, PAD and hyperlipidemia. She lives alone and is independent in activities of daily living. Her average life expectancy is about four years. Robust, non-diabetic, elderly patients at high risk for cardiovascular events have proven benefit from systolic blood pressure lowering less than 120. For those 80 years or older, controlling systolic blood pressure to less than 120 mmHg lowers the risk of heart attacks, stroke, death, and mild cognitive impairment, but increases the risk of decline in kidney function. I would ensure her one minute standing systolic blood pressure is over 110 before starting tx, and out of an abundance of caution, given her age, I would get close to 120 but not much below. I would start a low dose ACE Inhibitor and titrate up cautiously every couple of weeks. I hope this is helpful, pls do not hesitate to let me know if you have any other questions.