What is the clinical evidence from this study?

Study design: Review. Population: Hypertension. Intervention: Intensive blood pressure control (SBP <150 mmHg or <120 mmHg) vs. Standard blood pressure control.

January 1, 2019Open Access

Hypertension management in the elderly: What is the optimal target blood pressure?

Q: What are the key findings of this study?

Lowering systolic blood pressure to <150 mmHg or <120 mmHg in patients aged 70 years and older reduces cardiovascular events and mortality without increasing the risk of falls or kidney failure.

Q: What does this research mean for the field?

Lowering systolic blood pressure to <150 mmHg or <120 mmHg in patients aged 70 years and older reduces cardiovascular events and mortality without increasing the risk of falls or kidney failure. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Lowering systolic blood pressure to <150 mmHg or <120 mmHg in patients aged 70 years and older reduces cardiovascular events and mortality without increasing the risk of falls or kidney failure.

Structured PICO

Does intensive blood pressure control improve cardiovascular outcomes and mortality without increasing adverse events in elderly patients aged 70 years or older?

Population

Elderly patients (aged 70 years or older) with hypertension

Intervention

Intensive blood pressure control targets (e.g., systolic blood pressure <120 mmHg, <140 mmHg, or <150 mmHg)

Comparator

Standard or less intensive blood pressure control targets

Outcome

Cardiovascular morbidity, mortality, and safety outcomes (including hypotension, falls, fractures, and renal failure)hard clinical

Intensive blood pressure control in patients ≥70 years old reduces cardiovascular events and mortality without a clear increase in serious adverse events, supporting recent guideline targets of <130/80 mmHg with an individualized approach.

Limitations

Observational data included in the review can be affected by unavoidable confounding factors
Key trials like SPRINT excluded older adults residing in nursing homes, persons with type 2 diabetes, and those with low standing BP
Lack of well-designed studies evaluating the safety threshold in very old patients with multiple comorbidities or polypharmacy

Abstract

Hypertension is a common disease in the elderly associated with significant morbidity and mortality. Due to the complexity of this population, the optimal target of blood pressure (BP) control is still controversial. In this article, we conduct a literature review of trials published in English in the last 10 years which were specifically designed to study the efficacy and safety of various BP targets in patients who are 70 years or older. Using these criteria, we found that the benefits in the positive studies were demonstrated even with a minimal BP control (systolic BP SBP <150 mmHg) and continued to be reported for a SBP <120 mmHg. On the other hand, keeping SBP <140 mmHg seemed to be safely achieved in elderly patients. Although the safety of lowering SBP to <120 mmHg is debated, Systolic Blood Pressure Intervention Trial study has shown no increased risk of falls, fractures, or kidney failure in elderly patients with SBP lower than this threshold. While the recent guidelines recommended to keep BP <130/80 mmHg in the elderly, more individualized approach should be considered to achieve this goal in order to avoid undesirable complications. Furthermore, further studies are required to evaluate BP target in very old patients or those with multiple comorbidities.

AI에게 질문

Bookmark

View Full Paper