Study: Intensive BP Reduction in Older Patients Significantly Lowers CV Risk

Intensive blood pressure reduction is associated with significantly lower rates of major cardiovascular events and all-cause mortality among nondiabetic adults aged 75 years and older, according to the results of a recent study.

There is a lack of consensus among experts as to what systolic blood pressure (SBP) targets are appropriate for older patients, with recommendations ranging from 140 mm Hg to 160 mm Hg.
_______________________________________________________________________________________________________________________________________________________________________

In order to evaluate the effects of intensive SBP targets (less than 120 mm Hg) compared with standard targets (less than 140 mm Hg) in this population, the researchers conducted a multicenter, randomized clinical trial of patients who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). The participants were randomly assigned to either an intensive treatment group (n=1317) or a standard treatment group (n=1319).

Overall, 2510 of the participants provided complete follow-up data. After a median follow-up of 3.14 years, participants in the intensive treatment group had significantly lower rates of the primary cardiovascular outcome—a composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes—compared with the standard treatment group (102 vs 148 events, respectively). All-cause mortality was also significantly lower, with 73 deaths in the intensive treatment group and 107 in the standard treatment group. However, the overall rate of serious adverse events did not differ between the groups (48.4% in the intensive treatment group and 48.3% in the standard treatment group).

“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,” they researchers concluded.

—Michael Potts

Reference:
Reference: Williamson JD, Supiano MA, Applegate WB, et al; SPRINT Research Group. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial [published online May 19, 2016]. JAMA. doi:10.1001/jama.2016.7050