Federal health officials recently updated blood pressure guidelines for adults aged 65 and older, reflecting a shift toward more individualized care. The American Heart Association and American College of Cardiology issued new recommendations in April 2024, suggesting that those 65 and over may have slightly higher blood pressure targets depending on their overall health.
Previously, guidelines had urged people in this age group to maintain a blood pressure below 130/80 mm Hg. Now, experts say that a systolic pressure between 130 and 139 could be acceptable for many older adults, especially those managing other conditions or at greater risk of medication side effects. The goal is to balance the benefits of lowering blood pressure against potential harms from overtreatment.
These changes stem from emerging evidence that aggressive blood pressure control may not consistently improve outcomes for everyone. Studies over the past decade have prompted reassessment, as older adults often face challenges such as dizziness, falls, or kidney problems linked to certain blood pressure medications. The updated guidelines emphasize shared decision-making between patients and their healthcare providers to determine the most suitable target.
Dr. Sandra Liu, a geriatrician at the University of Michigan, highlights the importance of context. “Blood pressure management in older adults is not a one-size-fits-all situation,” she said. “We have to consider functional status, overall health, and patient preferences. Some people may benefit from tighter control, while others do better with more relaxed targets.”
The recommendations also encourage more frequent monitoring, including at-home measurements, to provide a fuller picture of blood pressure trends over time. This approach can help avoid unnecessary medication adjustments based on isolated readings at the doctor’s office.
For many people aged 65 and older, blood pressure remains a significant health concern, as it is a major risk factor for heart attack, stroke, and kidney disease. However, the updated guidelines aim to prevent overtreatment that might reduce quality of life or lead to complications. Adjusting blood pressure goals can also alleviate the financial and logistical burdens tied to multiple medications.
Community health organizations are taking note, and some clinics have started training staff to discuss the new guidelines with patients during routine visits. Pharmacists and nurse practitioners often play a key role in helping people understand how medications and lifestyle changes fit into these revised targets.
While the changes may cause some confusion initially, they reflect a broader trend in medicine toward personalized care, especially for older adults with diverse health needs. The emphasis is on thoughtful management that prioritizes safety and patient values alongside traditional measures of risk.
Where this leaves older adults is a more flexible framework for managing blood pressure. Rather than strict adherence to a singular number, a conversation about goals and the risks and benefits of treatment is now the foundation of care. For many, this shift offers reassurance that blood pressure management can be tailored to support their independence and well-being over time.
As more data emerge, these guidelines will continue to evolve, but the current approach marks an important step in refining care for a growing segment of the population.
