The AHA Guidelines and Scientific Statements Handbook

Chapter 11 Hypertension

target BP of <130/80 mm Hg in individuals with any
of the following: diabetes mellitus, chronic renal
disease, CAD, CAD risk equivalents (carotid artery
disease, peripheral arterial disease, aortic aneurysm),
and for high-risk patients, defi ned as those with a
10-year Framingham CAD risk score of ≤10% (Fig.
11.5), and a target BP of <140/90 mm Hg in indi-
viduals with none of the above (Class IIa; Level of
Evidence B). It is noteworthy that high risk is
common in older men; the Framingham database
tells us that the prevalence of a greater than 10% risk
for CAD in 10 years is about one third in the age
group 50–59 years, about two-thirds in 60–69 year-

olds and over 90% in those who are 70–79 years [26]

(Fig. 11.6).

In patients with an elevated DBP and CAD with

evidence of myocardial ischemia, the BP should be

lowered slowly, and caution is advised in inducing

falls of DBP below 60 mm Hg if the patient has dia-

betes mellitus or is over the age of 60 years. In older

hypertensive individuals with wide pulse pressures,

lowering SBP may cause very low DBP values

(<60 mm Hg). This should alert the clinician to

assess carefully any untoward signs or symptoms,

especially those due to myocardial ischemia. In the

very old, those over 80 years of age, antihypertensive

Framingham Heart Study:

Calculation of the 10-Year CHD Risk in Men and Women.

Fig. 11.5 Calculating a 10-year risk for coronary heart disease using Framingham point scores. Reprinted from the National Heart, Lung,
and Blood Institute as a part of the National Institutes of Health and the US Department of Health and Human Services, NIH Publication No.
01-3305. Available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/risk_tbl.htm