Key result
Targeting SBP <140 mm Hg reduces MACE ~17% versus 140-150 mm Hg in elderly hypertensives.
Why the study?
Does more aggressive blood pressure lowering (SBP <140 mm Hg) reduce cardiovascular events compared to less aggressive lowering (SBP 140-150 mm Hg) in hypertensive patients older than 60 years?
Meta-Analysis (n=53,993)
Does more aggressive blood pressure lowering (SBP <140 mm Hg) reduce cardiovascular events compared to less aggressive lowering (SBP 140-150 mm Hg) in hypertensive patients older than 60 years?
Effect estimate: RR 0.83 (95% CI 0.69-0.99)
Aggressive blood pressure lowering (SBP <140 mm Hg) in elderly hypertensives reduces cardiovascular events regardless of age, but increases the risk of renal failure, warranting close monitoring.
Supports targeting SBP <140 mm Hg in elderly hypertensives to reduce MACE; confirms benefit across ages but warrants renal monitoring.
BACKGROUND: The influence of age on balance of benefit vs. potential harm of blood pressure (BP)-lowering therapy for elderly hypertensives is unclear. We evaluated the modifying effects of age on BP lowering for various adverse outcomes in hypertensive patients older than 60 years without specified comorbidities. METHODS: All relevant randomized controlled trials (RCTs) were systematically identified. Coronary heart disease, stroke, heart failure (HF), cardiovascular death, major adverse cardiovascular events (MACE), renal failure (RF), and all-cause death were assessed. Meta-regression analysis was used to explore the relationship between achieved systolic BP (SBP) and the risk of adverse events. Random-effects meta-analysis was used to pool the estimates. RESULTS: Our study included 18 RCTs (n = 53,993). Meta-regression analysis showed a lower achieved SBP related with a lower risk of stroke and cardiovascular death, but an increased risk of RF. The regression slopes were comparable between populations stratifying by age 75 years. In subgroup analysis, the relative risks of a more aggressive BP lowering strategy were similar between patients aged older or less than 75 years for all outcomes except for RF (P for interaction = 0.02). Compared to treatment with final achieved SBP 140-150 mm Hg, a lower achieved SBP (<140 mm Hg) was significantly associated with decreased risk of stroke (relative risk = 0.68; 95% confidence interval = 0.55-0.85), HF (0.77; 0.60-0.99), cardiovascular death (0.68; 0.52-0.89), and MACE (0.83; 0.69-0.99). CONCLUSIONS: To treat hypertension in the elderly, age had trivial effect modification on most outcomes, except for renal failure. Close monitoring of renal function may be warranted in the management of elderly hypertension.
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Huang et al. (2018) conducted a meta-analysis in Hypertension (n=53,993). Aggressive blood pressure lowering (achieved SBP <140 mm Hg) vs. Standard blood pressure lowering (achieved SBP 140-150 mm Hg) was evaluated on MACE (RR 0.83, 95% CI 0.69-0.99). Aggressive blood pressure lowering (achieved SBP <140 mm Hg) in elderly hypertensives reduced the risk of MACE (RR 0.83; 95% CI 0.69-0.99) compared to 140-150 mm Hg, regardless of age.
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