Continuing the current treatment regimen with the calcium channel blocker amlodipine is appropriate. This 76-year-old patient has stage 1 hypertension and systolic blood pressure measurements in the range of 140 to 150 mm Hg. The treatment goal recommended in the eighth report of the Joint National Committee (JNC 8) for patients with hypertension who are ≥60 years is <150/90 mm Hg. Although she is near this goal, the benefits of further blood pressure reduction must be balanced with the potential risks of increasing a dose, changing the antihypertensive agent, or adding additional antihypertensive agents. Importantly, a recent study defining frailty as the inability to walk 6 meters in less than 8 seconds demonstrated no association with hypertension and mortality, and, in those who were unable to complete the walk test, a reduction in mortality was noted with increased blood pressure. This suggests that the risk of complications, morbidity, and mortality related to lower blood pressure in frail individuals may supersede the potential benefit of lower blood pressure goals.

In a 2017 guideline, the American College of Physicians and American Academy of Family Physicians addressed the treatment of hypertension in patients ≥60 years of age (Qaseem et al, 2017). The guideline includes three recommendations:

• Initiate treatment in patients ≥60 years of age with systolic blood pressure persistently at or above 150 mm Hg to achieve a target systolic blood pressure of less than 150 mm Hg to reduce the risk for mortality, stroke, and cardiac events.
• Consider initiating or intensifying pharmacologic treatment in patients ≥60 years of age with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for recurrent stroke.
• Consider initiating or intensifying pharmacologic treatment in some patients ≥60 years of age at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for stroke or cardiac events.

Although 24-hour ambulatory blood pressure monitoring may be more accurate in defining this patient's blood pressure, home blood pressure monitoring is a reasonable alternative because it is less expensive. Furthermore, additional information is not likely to influence therapy.