2014 EB Guideline for the Management of High blood pressure (BP) in Adults, report from the panel members appointed to the JNC 8 (JNC8P), recommended that in patients (pts.) aged ?60 year with systolic BP (SBP) ?150 or diastolic BP (DBP) ?90 mmHg, the goal of treatment would be SBP <150 and DBP <90 (Grade A). However,? SBP <140 mmHg for pts. <80 y-o. in line with guidelines from Europe, Canada, the UK, the ACCF, and the AHA, and the ASH/ISH is strongly suggested by the minority of JNC8P (Wright JT Jr., et al. Ann Intern Med 2014;160:499). Personally I would also give the same suggestion to apply the treatment of hypertension (Htn) in Taiwan, since stroke is more serious a problem than coronary heart disease (CHD) in Asians, and the impact of high BP is stronger on stroke than it is on CHD.
Nevertheless, it is remained unsettled (currently no trials of BP stratified by age to
　　support age-related divergent pathological mechanisms. Opie LH, Wiysonge CS. Reply. JAMA 2014;311:862) on the definition of ‘ elderly’, it is ?60 years old (y-o.), ?65, ?75 or ?80 y-o.? Nevertheless, strategies of the management for elderly ( ?80 y-o. ?) Htn would be better including the followings according to the new guideline of Japan Society of Htn:

1. Non-drug therapy should be positively performed, but strategies should be individually selected, considering the pts.' quality of life (QOL)
2. Drug therapy should be indicated for pts. with a BP of ?140/90?mmHg on principle. However, treatment indication must be individually assessed in persons aged > 75 y-o., with a SBP 140–149?mm?Hg or frail elderly, such as subjects who are unable to accomplish 6?min. walking.
3. Calcium channel blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors and low-dose diuretics are recommended as first-line anti-Htnsives as in non-elderly pts. Usually, the initial dose should (better?) be half of the standard dose. If anti-Htnsive effects are insufficient, combination therapy of these drugs should be initiated.
4. In pts. with complications, choice of anti-Htnsives should be individualized. BP should be gradually reduced with due attention to adverse effects, organ damages and QOL. In pts. with orthostatic hypotension, the BP? must be more slowly controlled.
5. Target BP in persons aged <75 years should be <140/90?mmHg and that in those aged > 80 y-o. should be <150/90?mm?Hg. Nevertheless, if treatment is well tolerated, BP <140/90?mmHg may further improve the outcome.
6. In pts. with CHD, the risk of cardiac events may increase if DBP <70?mmHg. Therefore, BP control should be performed while monitoring the absence of significant coronary stenosis, symptoms of myocardial ischemia and ECG findings.