The treatment of older people with high blood pressure (BP) is a challenge as under- and over-treatment can lead to poorer outcomes. There is strong evidence from epidemiological and trial data to show that older people with high BP should be treated at the same threshold and to the same target BP (BP <140/90 mmHg) as younger patients, with the exception of the very elderly (those over the age of 80 years), in whom a less aggressive treatment target is recommended (BP <150/90 mmHg). With anti-hypertensive therapy, older people can experience orthostatic hypotension, drug–drug interactions and adverse drug reactions; older people often have complex co-morbidities and may have barriers to adherence to therapy. Drug therapy should be tailored to achieve a satisfactory BP reduction with minimal adverse effects. Other risk factors for cardiovascular disease in older people should be identified and addressed. Particular consideration should be given to the use of statins.

Paresh Parmar - Care of older people and stroke pharmacist, Northwick Park Hospital, Harrow

Helen Williams - Consultant pharmacist for cardiovascular disease, Medicines Optimisation Team, NHS Southwark CCG, London