Norsk
Norwegian College of General Practice/Norwegian Association of Old Age and Nursing Home Medicine

Avoid initiating antihypertensive treatment in frail adults over 70 years with systolic blood pressure <160 mmHg or diastolic blood pressure <90 mmHg without assessing benefit versus risk 

22. JULI 2025

Rationale 

There is strong evidence supporting hypertension treatment in older adults. Lowering blood pressure below 160 mmHg reduces the risk of stroke, death, and heart failure. However, there is little evidence that further reduction is beneficial. Many elderly adults have calcified blood vessels and may experience symptoms of reduced cerebral perfusion when blood pressure is lowered. It is also important to assess orthostatic hypotension, as it is associated with increased mortality and cardiovascular events.  
  
References  

  • Angelousi, A. et al (2014). "Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis." J Hypertens 32(8): 1562-1571; discussion 1571.
  • James, P. A. et al (2014). "2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)." JAMA 311(5): 507-520.
  • Reeve, E., et al. (2020). "Withdrawal of antihypertensive drugs in older people." Cochrane Database of Systematic Reviews(6).