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Data are Needed on Target Blood Pressure for Elderly People

To the Editor: The observational data reported by Ungar et al. are of interest, but they are not data collected in a randomized, double-blind, placebo-controlled antihypertensive drug study. On the basis of data available at the time, an editorial proposed that unless the Hypertension in the Very Elderly Trial (HYVET) showed that antihypertensive drug therapy was not beneficial in patients aged 80 and older, this group should receive antihypertensive drug treatment. Goodwin disagreed with this approach, and eight commentaries, some of which supported the treatment of very elderly patients with hypertension and some of which did not, accompanied his response to the editorial. The results from HYVET have settled this controversy. At 1.8-year median, antihypertensive drug therapy administered in a study of 3,845 persons, mean age 83.6, reduced follow-up fatal or nonfatal stroke by 30% (P 5.06), fatal stroke by 39% (P 5.05), all-cause mortality by 21% (P 5.02), cardiovascular mortality by 23% (P 5.06), and heart failure by 64% (Po.001).3 However, data are needed on target blood pressure for elderly people. Should target blood pressure goal in elderly people be a systolic blood pressure less than 140 mmHg, less than 130 mmHg, or less than 120 mmHg? How low should diastolic blood pressure be allowed to reach? Further research is needed to answer these questions.