Background translation of the available evidence concerning primary cardiovascular prevention into clinical guidance for the heterogeneous population of older adults is challenging. With this review, we aimed to give an overview of the thresholds and targets of antihypertensive drug therapy for older adults in currently used guidelines on primary cardiovascular prevention. Secondly, we evaluated the relationship between the advised targets and guideline characteristics, including guideline quality. Methods we systematically searched PubMed, Embase, Emcare and five guideline databases. We selected guidelines with (i) numerical thresholds for the initiation or target values of antihypertensive drug therapy in context of primary prevention (January 2008–July 2020) and (ii) specific advice concerning antihypertensive drug therapy in older adults. We extracted the recommendations and appraised the quality of included guidelines with the AGREE II instrument. Results thirty-four guidelines provided recommendations concerning antihypertensive drug therapy in older adults. Twenty advised a higher target of systolic blood pressure (SBP) for octogenarians in comparison with the general population and three advised a lower target. Over half of the guidelines (n = 18) recommended to target a SBP <150 mmHg in the oldest old, while four endorsed targets of SBP lower than 130 or 120 mmHg. Although many guidelines acknowledged frailty, only three gave specific thresholds and targets. Guideline characteristics, including methodological quality, were not related with the recommended targets. Conclusion the ongoing debate concerning targets of antihypertensive treatment in older adults, is reflected in an inconsistency of recommendations across guidelines. Recommended targets are largely set on chronological rather than biological age.

中文翻译：

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我们是否同意老年人抗高血压药物治疗的目标：心血管疾病一级预防指南的系统评价

将有关初级心血管预防的现有证据背景转化为老年人异质人群的临床指导具有挑战性。通过这篇综述，我们旨在概述目前使用的心血管初级预防指南中老年人抗高血压药物治疗的阈值和目标。其次，我们评估了建议目标与指南特征之间的关系，包括指南质量。方法我们系统地搜索了 PubMed、Embase、Emcare 和五个指南数据库。我们选择了以下指南：(i) 在一级预防的背景下（2008 年 1 月至 2020 年 7 月）抗高血压药物治疗的起始值或目标值的数值阈值和 (ii) 关于老年人抗高血压药物治疗的具体建议。我们提取了建议，并使用 AGREE II 工具评估了纳入指南的质量。结果 三十四条指南提供了有关老年人抗高血压药物治疗的建议。与一般人群相比，20 名建议八十多岁的人设定更高的收缩压 (SBP) 目标，三名建议降低目标。超过一半的指南 (n = 18) 建议将最年长老年人的 SBP 设定为 <150 mmHg，而四个认可的 SBP 目标是低于 130 或 120 mmHg。尽管许多指南承认其脆弱性，但只有三个给出了具体的阈值和目标。指南特征，包括方法学质量，与推荐的目标无关。结论 关于老年人抗高血压治疗目标的持续争论，反映在指南之间的建议不一致。推荐的目标主要是按实际年龄而不是生物学年龄设定的。