The new guidelines do make exceptions for special populations, such as those with diabetes and the elderly. For those with diabetes, the ESH/ESC writing committee recommend that physicians treat patients to <85 blood="" diastolic="" hg="" mm="" p="" pressure.="">
In patients younger than 80 years old, the systolic blood-pressure target should be 140 to 150 mm Hg, but physicians can go lower than 140 mm Hg if the patient is fit and healthy. The same advice applies to octogenarians, although physicians should also factor in the patient's mental capacity in addition to physical heath if targeting to less than 140 mm Hg.
On the whole, Dr Giuseppe Mancia (University of Milano-Bicocca, Milan, Italy), cochair of the ESH/ESC writing committee, said there is a shift toward "greater conservatism" with regard to drug treatment in the new guidelines. That said, the guidelines explicitly state physicians make decisions on treatment strategies based on the patient's overall level of cardiovascular risk.
Mancia said the guidelines are not prescriptive, or orders, but rather suggestions for practicing physicians. While there are some aspects of care that remain the domain of expert opinion, he said there is "no question that blood pressures exceeding 140/90 mm Hg increase the risk of cardiovascular disease and stroke," and these are both associated with a massive worldwide socioeconomic cost. Mancia added that 60% of patients remain disabled at one year following a stroke.