Hypertension in the Oldest Old, Beyond Guidelines

Oldest old subjects represent a fast rising share of world population characterized by complex clinical features, including high vascular risk and uncertainty regarding risk-to-benefit ratio of antihypertensive treatment. European guidelines in 2013 have introduced the need to personalize antihypertensive treatment targets according to age and health status. Approach to clinical assessment of blood pressure in old age is peculiar, including the need for orthostatic hypotension assessment, the frequent usefulness of ambulatory blood pressure monitoring, and the role of functional and cognitive measures to screen for frailty. Observational and intervention studies published during the last years suggest that a strict BP control might be beneficial in some older subjects but might harm other ones, probably the frailest. Future epidemiological and intervention studies including specific profiles of frailty are warranted, to identify the most appropriate blood pressure targets in the perspective of personalized medicine.