DB 02-3 STRICT CONTROL OF HYPERTENSION IN THE ELDERLY WITH DIABETES AND CHRONIC KIDNEY DISEASE (PRO).

The identification of explicit blood pressure targets for clinical management remains controversial, particularly in older individuals with co-morbidities. Recommendations from the panel appointed to the Eighth Joint National Committee (JNC 8) and results of the SPRINT trial have rekindled interest in this issue. JNC8 recommended a higher (more relaxed) BP goal of < 150/90, instead of the traditional BP goal of <140/90, in persons aged 60+. In contrast, the recently completed SPRINT trial, which enrolled high risk patients without diabetes, documented that a lower (more stringent) SBP goal of <120 mmHg reduced total mortality and cardiovascular disease events compared to <140 mmHg. Concurrently, there is substantial and burgeoning interest in 'precision' or 'personalized' medicine, which highlights the potential for individualization of clinical management based on biomarkers, genetic factors, and other patient attributes. Interest in personalized medicine is actually an extension of prior efforts to use estimated CVD risk to guide decision making on anti-hypertensive therapy. Overall, in the context of available evidence (including observational studies and clinical trials), prior guidelines, and several practical considerations, strict control of hypertension to <140/90, if not < 120/80 mmHg, should be the goal in elderly patients with diabetes and chronic kidney disease.