Intensive vs. Standard Ambulatory Blood Pressure Lowering to Lessen Functional Decline in the Elderly - INFINITY

Contribution To Literature:

The INFINITY trial failed to show that intensive ambulatory BP lowering was superior at improving mobility and cognitive function. 

Description:

The goal of the trial was to evaluate intensive ambulatory blood pressure (BP) lowering compared with standard ambulatory BP lowering among elderly patients with hypertension.


Study Design

  • Randomized
  • Parallel

Elderly patients with hypertension were randomized to intensive ambulatory BP lowering (systolic ≤130 mm Hg; n = 99) versus standard ambulatory BP lowering (systolic = 145 mm Hg; n = 100).

  • Total number of enrollees: 199
  • Duration of follow-up: 3 years
  • Mean patient age: 80 years
  • Percentage female: 58%

Inclusion criteria:

  • Office systolic BP 150-170 mm Hg on ≥1 antihypertensive drug or >170 mm Hg on 0-1 antihypertensive drug
  • 24-hour ambulatory systolic BP (SBP) ≥140 mm Hg
  • White matter hyperintensity on brain magnetic resonance imaging

Exclusion criteria:

  • Unstable cardiovascular or chronic neurologic condition

Other salient features/characteristics:

  • Ambulatory SBP at 3 years: 130.9 mm Hg in the intensive group compared with 146.0 mm Hg in the standard group

Principal Findings:

The co-primary outcome, percent change from baseline to end of study white matter hyperintensity, was 0.29 in the intensive group compared with 0.48 in the standard group (p = 0.03).

The co-primary outcome, change from baseline to end of study gait speed, was 0.4 in the intensive group compared with 0.4 in the standard group (p = 0.91).

Secondary outcomes:

  • Change from baseline to end of study symbol digit modalities test: -2 in the intensive group compared with -1 in the standard group (p = 0.29)
  • Nonfatal cardiovascular event: 4.1% in the intensive group vs. 17% in the standard group (p < 0.01)

Interpretation:

Among elderly patients with hypertension, intensive lowering of SBP reduced the development of subcortical white matter disease. However, intensive lowering of SBP was not associated with improvement in mobility or cognitive function. Intensive lowering of SBP was associated with a reduction in nonfatal cardiovascular events.


References:

Presented by Dr. William B. White at the American College of Cardiology Annual Scientific Session (ACC 2019), New Orleans, LA, March 18, 2019.

Clinical Topics: Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Noninvasive Imaging, Prevention, Vascular Medicine, Magnetic Resonance Imaging, Hypertension, Sleep Apnea

Keywords: ACC Annual Scientific Session, ACC19, Antihypertensive Agents, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Cognition, Dementia, Vascular, Gait, Geriatrics, Hypertension, Magnetic Resonance Imaging, Metabolic Syndrome X, Mobility Limitation, Primary Prevention


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