Among adults 75 years of age or older, treating to a systolic blood pressure target of less than 120 mm Hg can significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause, according to a study published online by JAMA.
In the United States, 75 percent of persons older than 75 years have hypertension, for whom cardiovascular disease complications are a leading cause of disability, illness and death.
The optimal systolic blood pressure (SBP) treatment target in geriatric populations with hypertension remains uncertain.
Jeffrey D. Williamson, M.D. of the Wake Forest School of Medicine and colleagues analyzed a subgroup (persons age 75 years or older with hypertension but without diabetes) in the Systolic Blood Pressure Intervention Trial (SPRINT).
These patients were randomly assigned to an SBP target of less than 120 mm Hg or an SBP target of less than 140 mm Hg.
Among the participants (average age, 80 years; 38 percent women), 95 percent provided complete follow-up data.
At a median follow-up of 3.1 years, there was a significantly lower rate of the primary composite outcome (nonfatal heart attack, acute coronary syndrome not resulting in a heart attack, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes; 102 events in the intensive treatment group vs 148 events in the standard treatment group).
There was also a significantly lower rate of all-cause death (73 deaths vs 107 deaths, respectively).
Additional analysis suggested that the benefit of intensive BP control was consistent among persons in this age range who were frail or had reduced gait speed.
The overall rate of serious adverse events was not different between treatment groups.
“Considering the high prevalence of hypertension among older persons, patients and their physicians may be inclined to underestimate the burden of hypertension or the benefits of lowering BP, resulting in under-treatment.”
“On average, the benefits that resulted from intensive therapy required treatment with 1 additional antihypertensive drug and additional early visits for dose titration and monitoring,” the authors write.
“Future analyses of SPRINT data may be helpful to better define the burden, costs, and benefits of intensive BP control.”
“However, the present results have substantial implications for the future of intensive BP therapy in older adults because of this condition’s high prevalence, the high absolute risk for cardiovascular disease complications from elevated BP, and the devastating consequences of such events on the independent function of older people.”
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News source: The JAMA Network. The content is edited for length and style purposes.
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