Summary

We clarified the diagnostic and therapeutic challenges associated with pseudohypertension in very elderly patients. Pseudohypertension is diagnosed when cuff blood pressure measurements for both systolic and diastolic blood pressure are significantly higher than direct intra-arterial blood pressure recordings. Pseudohypertension is considered a manifestation of combined intimal and medial arterial calcifications. Non-invasive diagnosis is extremely difficult, but pseudohypertension should be considered in certain groups of very elderly hypertensive patients. Importantly, most of the very elderly patients diagnosed with pseudohypertension present with hypertension, especially isolated systolic hypertension, and this condition should be treated. Treatment must be undertaken cautiously (start low, go slow), with a recommended target blood pressure ≤ 150/80 mmHg. Orthostatism should be measured routinely, both by the patient and the attending physician.