Will Lowering BP Targets Decrease CV Events and Death in Older Patients?

Among adults 75 years of age or older, treating to a systolic blood pressure (BP) target of less than 120 mm Hg compared with less than 140 mm Hg may result in considerably lower rates of death and major cardiovascular events, according to a study published May 19 in the Journal of the American Medical Association and simultaneously presented at the American Geriatrics Society Annual Scientific Meeting in Long Beach, CA.

Jeffrey D. Williamson, MD, MHS, et al., conducted a multicenter, randomized clinical trial in which a subgroup of patients from the SPRINT Trial aged 75 years or older who had hypertension but not diabetes, were randomly assigned to a systolic BP target of less than 120 mm Hg (intensive treatment group, n = 1,317) or a systolic BP target of less than 140 mm Hg (standard treatment group, n = 1,319).

Results show that patients in the intensive treatment group had a significantly lower rate of the primary composite outcome – nonfatal myocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure and death from cardiovascular causes – than the standard treatment group at a 3.1-year follow-up. In addition, there were 102 events in the intensive treatment group vs. 148 events in the standard treatment group. The intensive treatment group also had a substantially lower rate of death from any cause. 

“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 undertreatment,” the authors state. “On average, the benefits that resulted from intensive therapy required treatment with one additional antihypertensive drug and additional early visits for dose titration and monitoring,” they add.

In an accompanying editorial, Aram V. Chobanian, MD, FACC, a member of ACC’s Geriatric Cardiology Section, remarks that “achieving the systolic BP goal of less than 130 mm Hg may be challenging for clinicians, because doing so could require use of additional medications, more careful monitoring, and more frequent clinic visits. Nevertheless, the important results … cannot be discounted, and unless unexpected adverse effects are observed on further examination of the trial data, then major changes in treatment goals for patients 75 years or older with hypertension will be warranted.”

Clinical Topics: Acute Coronary Syndromes, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension

Keywords: Acute Coronary Syndrome, Ambulatory Care, Antihypertensive Agents, Blood Pressure, Diabetes Mellitus, Geriatrics, Goals, Heart Failure, Hypertension, Hypotension, Myocardial Infarction, Prevalence, Stroke

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