Management of Hypertension in Older Adults

Hypertension is a major risk factor for cardiovascular disease, and its prevalence increases with age.Aging is associated with distinct pathophysiological changes that lead to various clinical manifestations, one of the most characteristic being isolated systolic hypertension in older adults.Large-scale studies such as Systolic Blood Pressure Intervention Trial, Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients Trial, and Hypertension in the Very Elderly Trial have elucidated the benefits of blood pressure control in older adults.Reflecting these results, recent hypertension guidelines have lowered the target blood pressure levels for older adults; however, the target levels are not the same among guidelines.According to the 2026 Korean Society of Hypertension guidelines, the target blood pressure for older adults is <140/90 mmHg.In contrast, the 2025 American Heart Association and the 2025 Japanese Society of Hypertension guidelines recommend a target of <130/80 mmHg, and the 2024 European Society of Cardiology guidelines suggest a target range of 120-129/70-79 mmHg.Both the 2026 Korean and 2025 Japanese guidelines strongly recommend calcium channel blockers as pharmacological treatment.In older adults, beta-blockers are generally not recommended as first-line agents unless there is a compelling indication.When managing hypertension in older adults, careful monitoring for potential complications including orthostatic hypotension, falls, and electrolyte imbalances, is essential.