Hypertension in very elderly patients >80 years of age need not be controlled as young i.e. <120/80 mm of Hg.
They should be stabilized around 140/90 mm of Hg.
Indapamide and/or perindopril are good for them as seen in the trail mentioned below.
Elderly Hypertensive Patients Benefit From Treatment: ACC/AHA
While most clinical trials exclude the very old, many modern hypertension clinical trials have substantial cohorts of older patients, said Pepine. In these trials, the responses to antihypertensive treatment and the effects on clinical outcomes were the same among the elderly cohorts as in the overall trial results. In addition, the recently published Hypertension in the Very Elderly Trial (HYVET) cemented the benefit of treatment in older patients when investigators showed that antihypertensive treatment with a sustained-release formulation of the diuretic indapamide, with or without the addition of perindopril, significantly reduced fatal stroke, all-cause mortality, and heart failure in patients 80 years of age and older.
The ACC/AHA writing committee recommends treatment with a single drug for patients >80 years of age, followed by a second drug if needed, in order to achieve a systolic blood pressure of 140 to 145 mm Hg. The writing committee states that low-dose thiazides, calcium antagonists, and renin-angiotensin-aldosterone system (RAAS) blockers are preferred, but the use of concomitant medications will likely dictate drug therapy. For individuals aged 65 to 79 years old, the committee recommends a treatment target of less than 140/90 mm Hg.
The writing committee also notes that elderly patients can benefit from lifestyle modifications, including weight reduction, adopting the Dietary Approaches to Stop Hypertension (DASH) diet, reducing salt intake, increasing physical activity, and moderating alcohol consumption. Lifestyle changes can lower blood pressure by 7 mm Hg or 8 mm Hg, Pepine noted, and these recommendations are pertinent even among elderly patients not yet hypertensive.