Geriatrics: Practical Issues in Hypertensive Care

By Spencer Carter, M.D.

Assistant Professor of Internal Medicine

At #AHA25, I had the pleasure of moderating a session devoted to the practical challenges of managing hypertension in older adults – a population in which blood pressure control remains both essential and complex. While the session addressed the full spectrum of geriatric hypertension, considerable attention centered on one of the most challenging subsets: patients with orthostatic hypotension.

Our panel explored strategies for managing these individuals, emphasizing that despite the risk of orthostasis, elevated blood pressure – rather than low blood pressure – remains the principal driver of adverse cardiovascular outcomes. Effective management requires individualized therapy that maintains adequate standing tolerance without compromising long-term blood pressure control. A recurring theme was the harm of reactive or PRN antihypertensive dosing, which tends to destabilize control and worsen outcomes. Instead, scheduled regimens, often supported by careful adjustment of timing and formulation, offer a more reliable approach.

Equally important, the conversation turned to the social, racial, and cultural dimensions of geriatric hypertension care. Drawing on themes from a recent Clinics in Geriatric Medicine article I co-authored with Shawna Nesbitt, M.D. (November 2024), we examined how disparities in income, living circumstances, access to care, and health literacy contribute to poorer outcomes among minoritized older adults. Achieving equity in hypertension management requires clinicians to consider these contextual factors as part of a comprehensive care plan, not as peripheral concerns. This session at #AHA25 highlighted that optimizing blood pressure management in older adults demands both scientific precision and a commitment to understanding the broader social landscape in which our patients live and age.