In U.S. adults 80 years and older taking antihypertensive agents for systolic blood pressure (SBP), intensive SBP control is associated with a reduced risk of death from cardiovascular disease, supporting guidelines for intensive BP control, according to a brief report published March 17 in JACC and being presented at ACC.25 in Chicago.

Current guidelines for intensive BP control lack evidence to support recommendations for patients 80 years and older. By leveraging nationally representative National Health and Examination Survey (NHANES) data, Huanhuan Yang, PhD, Erica S. Spatz, MD, MHS, FACC, Harlan M. Krumholz, MD, SM, FACC, et al., examined the association between the level of SBP and cardiovascular disease mortality being actively treated for hypertension in that age group.

The authors examined data collected from 1988 through 2014 linked to the National Death Index through December 2019 for 1,593 adults (949 women). SBP was measured following standardized protocols and they used the mean value of the second and third measurements. SBP was categorized into three groups: <130 mm Hg, 130-160 mm Hg (reference group, based on 2017 ACC/American Heart Association and 2018 European Society of Cardiology guidelines), and >160 mm Hg. The primary outcome was cardiovascular disease mortality.

Over the mean 6.7 years of follow-up, results showed there were 1,295 deaths, of which 596 (46%) were attributed to cardiovascular disease. A lower level of SBP was associated with a lower cardiovascular mortality risk, with a significantly lower risk at SBP levels <130.8 mm Hg and a significantly higher risk at >145.0 mm Hg. Compared with an SBP 130-160 mmHg, the adjusted hazard ratio was 0.74 for treated SBP <130 mm Hg.

"Our study extends the prior literature by specifically focusing on adults aged 80+ years, a group often under-represented in clinical trials," write the authors. While there is evidence that lowering BP lowers risk of cardiovascular disease, the authors write their findings demonstrate it is significantly associated with reduced CVD mortality risk, "supporting rigorous SBP management." Yet, they note that individualized treatment plans remain essential, particularly for frail individuals and those with comorbidities.