{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:21:34Z","timestamp":1783596094660,"version":"3.55.0"},"reference-count":35,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Hypertension (HTN) management is essential to improving cardiovascular and cerebrovascular morbidity and mortality in the older adult, yet optimal blood pressure (BP) targets remain uncertain. We aim to compare the incidence of major adverse cardiovascular events (MACE) among older adults presenting to the emergency department (ED) with systolic blood pressure (SBP) 140\u2013159 mmHg and diastolic blood pressure (DBP) 90\u201399 mmHg versus those with SBP \u2265 160 mmHg and DBP \u2265 100 mmHg. Methods: Retrospective analysis was conducted using the Global Collaborative Network including adults aged \u2265 65 years presenting to the ED with essential HTN without end-stage renal disease. Cohort 1 (SBP \u2265 160 mmHg and DBP \u2265 100 mmHg) included older adults with more severely elevated BP, while Cohort 2 (SBP 140\u2013159 mmHg and DBP 90\u201399 mmHg) included those with moderately elevated BP. The primary outcome was all-cause mortality over 5 years. Secondary outcomes included AKI, CHF, AMI, ischemic stroke, and hemorrhagic stroke. Propensity score matching was used to balance baseline characteristics. Results: After propensity score matching, 191,829 patients remained in each cohort. The mean age was 72.6 (\u00b15.9) years; 51.8% were female, 10.5% had diabetes mellitus, and 5.65% were obese. Cohort 2 (SBP 140\u2013159 mmHg) had lower risks across all primary and secondary outcomes compared with Cohort 1 (SBP \u2265 160 mmHg). The largest risk difference (RD) was observed for AKI (RD = 1.28%; 95% CI, 1.09\u20131.46%; p &lt; 0.0001), followed by ischemic stroke (RD = 1.25%; 95% CI, 1.11\u20131.39%; p &lt; 0.0001), CHF (RD = 1.11%; 95% CI, 0.93\u20131.29%; p &lt; 0.0001), AMI (RD = 0.70%; 95% CI, 0.58\u20130.83%; p &lt; 0.0001), all-cause mortality (RD = 0.33%; 95% CI, 0.15\u20130.51%; p &lt; 0.0001), and hemorrhagic stroke (RD = 0.29%; 95% CI, 0.22\u20130.36%; p &lt; 0.0001). All outcomes demonstrated consistently higher absolute risk in Cohort 1 compared with Cohort 2. Conclusion: Cohort 2 (SBP 140\u2013159 mmHg) was associated with a statistically significant but small decrease in cardiovascular, cerebrovascular, and mortality outcomes, with all absolute RDs uniformly small (&lt;1%) and minimal survival benefit over time. These small gains must be weighed against overtreatment risks, such as medication costs, hypotension, and falls, underscoring the need for individualized, risk-based HTN management in older adults.<\/jats:p>","DOI":"10.3390\/jcm15145380","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:16:22Z","timestamp":1783592182000},"page":"5380","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Elevated Blood Pressure on Cardiovascular and Cerebrovascular Outcomes in Older Adults: A Propensity-Matched Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Jigar","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronaldo","family":"Pichardo-Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6157-9302","authenticated-orcid":false,"given":"Samantha","family":"Camp","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7774-154X","authenticated-orcid":false,"given":"Quincy K.","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA"},{"name":"Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0270-5867","authenticated-orcid":false,"given":"Adil","family":"Ather","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3125-4401","authenticated-orcid":false,"given":"Leah","family":"Steckler","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic S.","family":"Raj","sequence":"additional","affiliation":[{"name":"Division of Renal Diseases and Hypertension, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8440-8454","authenticated-orcid":false,"given":"Ali","family":"Pourmand","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","unstructured":"Ostchega, Y., Fryar, C.D., Nwankwo, T., and Nguyen, D.T. 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