REGARDS: A Closer Look at Optimal Blood Pressure Levels for Elderly Patients

The recommended systolic blood pressure (SBP) for all patients over the age of 55 years should be <140 mmHg, with optimal values possibly between 120-139 mmHg, according to results from the REGARDS Study presented as part of the ESC Congress 2013 in Amsterdam.

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The study, which followed 13,948 U.S. adults for a median of 4.5-6 years to evaluate stroke, coronary heart disease and all-cause mortality, found that SBP greater than 150 mmHg carried the highest risk for cardiovascular disease, and SBP between 130 and 139 carried the lowest CVD risk for those between 55 and 64 (HR=0.88) and 75 or older (HR=0.69).

Coronary heart disease incidence increased progressively with increasing SBP for participants younger than 75. The incidence of stroke increased for SBP of 130 and higher for those aged 65 to 74. For participants 75 years and older, SBP of 150 and higher was associated with increased risk of stroke, but there was no association for SBP between 120 mmHg and 149 mmHg. For participants younger than 75, SBP of 140 and higher was associated with higher all-cause mortality. There was no association between SBP and all-cause mortality for participants aged 75 and older.

"The results suggest a hypothesis that for all patients aged 55 and older, the recommended level of systolic blood pressure should be less than 140 mmHg, including the oldest patients," said lead author Maciej Banach, MD, PhD, chair of nephrology and hypertension, Medical University of Lodz, Poland.

Given that REGARDS was an observational study and, as such, could not establish direct causality between blood pressure and cardiovascular outcomes, Banach suggests that large, interventional randomized controlled trials are needed to provide definitive insights into the optimal blood pressures levels in older individuals. He also suggests that all future trials take into account an individual's frailty status.

Keywords: Incidence, Risk, Stroke, Cardiovascular Diseases, Coronary Disease, Blood Pressure, Hypertension

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