Abstract
Hypertension affects 80% of adults 80 years of age or older and is a leading cause of morbidity and mortality through its fundamental role as a risk factor for cardiovascular disease, stroke, kidney disease, and cognitive impairment. Antihypertensive therapy reduces the risk of coronary artery disease, heart failure, atrial fibrillation, stroke, and cognitive decline among patients in this age group, but older patients with advanced frailty, cognitive impairment, complex comorbidities, or nursing home residence have largely been excluded from clinical trials. This article reviews the epidemiology, pathophysiology, diagnosis, and management of hypertension in the oldest old, herein defined as age ≥80 years. We propose the geriatrics 4 Ms model as a framework for providing individualized patient-centered care for the oldest patients with hypertension. Additional research is needed in patients who have been under-represented in clinical trials and to assess the role of deprescribing in the care of older patients with hypertension.