Adults 75 years and older with hypertension, including those in overall poor health and the medically fragile, could benefit from interventions meant to lower blood pressure below current medical guidelines, according to research published in JAMA and presented at the American Geriatrics Society Annual Scientific Meeting.
Mark Supiano, MD, chief of geriatrics at University of Utah Health Care and director of the VA Salt Lake City Geriatric Research, Education, and Clinical Center, and colleagues conducted a multicenter, randomized clinical trial of patients aged 75 years and older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). A total of 2639 patients were randomized to either an intensive treatment group or a standard treatment group; patients in the intensive treatment group had a systolic blood pressure (SBP) target of less than 120 mm Hg (n=1317), while patients in the standard treatment group had an SBP target of less than 140 mm Hg.
At a median follow-up of 3.14 years, the researchers found a significantly lower rate of the primary cardiovascular disease outcome – a composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes – with 102 events in the intensive treatment group versus 148 events in the standard treatment group.
“This subgroup analysis of the SPRINT trial is significant because many physicians and patients have been concerned about blood pressure being too low in the elderly,” noted Alfred Cheung, MD, chief of nephrology and hypertension at University of Utah Health Care. “These results are reassuring and could very well change current medical practice by lowering the blood pressure goal even in people over 75 years old.”
“Among ambulatory adults aged 75 years or older, treating to an SBP target of less than 120 mm Hg compared with an SBP target of less than 140 mm Hg resulted in significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause,” concluded Dr Supiano.
- Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥ 75 years. A randomized clinical trial. JAMA. 2016; doi: 10.1001/jama.2016.7050