Does strict blood pressure control (<140 mm Hg) reduce cardiovascular mortality and morbidity in elderly patients with isolated systolic hypertension compared to moderate control?
In elderly patients with isolated systolic hypertension, strict blood pressure control (<140 mm Hg) did not significantly reduce cardiovascular events compared to moderate control, though the trial was underpowered.
In this prospective, randomized, open-label, blinded end point study, we aimed to establish whether strict blood pressure control ( or =140 mm Hg to or =2 years. The strict control (1545 patients) and moderate control (1534 patients) groups were well matched (mean age: 76.1 years; mean blood pressure: 169.5/81.5 mm Hg). Median follow-up was 3.07 years. At 3 years, blood pressure reached 136.6/74.8 mm Hg and 142.0/76.5 mm Hg, respectively. The blood pressure difference between the 2 groups was 5.4/1.7 mm Hg. The overall rate of the primary composite end point was 10.6 per 1000 patient-years in the strict control group and 12.0 per 1000 patient-years in the moderate control group (hazard ratio: 0.89; 95% CI: 0.60 to 1.34; P=0.38). In summary, blood pressure targets of or = 70 years of age with isolated systolic hypertension, although our trial was underpowered to definitively determine whether strict control was superior to less stringent blood pressure targets.
Ogihara et al. (2010) studied this question.