Lowering Systolic BP Targets Reduces Rate of Cardiovascular Events

Aiming for a systolic blood pressure (SBP) target of less than 120 mm Hg in seniors results in significantly lower rates of major cardiovascular events and death.

Researchers at Wake Forest Baptist Medical Center (Winston-Salem, NC, USA), the University of Utah (Salt Lake City, USA), and other institutions conducted a study to evaluate the effects of SBP targets in 2,636 patients aged 75 years or older with hypertension, but without diabetes. Study participants were randomized to an SBP target of less than 120 mm Hg (intensive treatment group, 1,317 patients), or to an SBP target of less than 140 mm Hg (standard treatment group, 1,319 patients).

The primary cardiovascular disease (CVD) outcome was a composite of nonfatal myocardial infarction (MI), acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes. All-cause mortality was a secondary outcome. The results showed that at a median follow-up of 3.14 years, there were 102 events in the intensive treatment group compared to 148 events in the standard treatment group.

There was also a significantly lower rate of all-cause death (73 deaths versus 107 deaths, respectively). Additional analysis suggested that the benefit of intensive SBP control was consistent even 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. The study was published online on May 19, 2016, in JAMA.

“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,” concluded lead author Jeffrey Williamson, MD, MHS, of Wake Forest, and colleagues. “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.”

Related Links:
Wake Forest Baptist Medical Center
University of Utah