Key result
Intensive BP treatment reduces major CV events ~26% vs. standard care in hypertensive older adults.
Why the study?
Managing blood pressure reduces CVD risk, but optimal treatment thresholds in older adults remain unclear due to the need to balance benefit against hypotension-related adverse events.
Does intensive blood pressure treatment reduce major cardiovascular events in older adults with hypertension?
Meta-Analysis (n=65,890)
Yes
Does intensive blood pressure treatment reduce major cardiovascular events in older adults with hypertension?
Effect estimate: RR 0.74 (95% CI 0.64-0.86)
Absolute Event Rate: 5.17% vs 7.07%
p-value: p=0.000
Intensive blood pressure treatment in older hypertensive adults without comorbidities significantly reduces major cardiovascular events and mortality, with a low rate of hypotension-related adverse events.
Supports intensive BP targets in older hypertensives; reinforces RCT evidence for event reduction.
Managing blood pressure reduces CVD risk, but optimal treatment thresholds remain unclear as it is a balancing act to avoid hypotension-related adverse events. This systematic review, meta-analysis and meta-regression evaluated the benefits of intensive BP treatment in hypertensive older adults. We systematically searched PubMed, MEDLINE, EMBASE, and the Cochrane Library of Controlled Trials until January 31, 2020. Studies comparing different BP treatments/targets and/or active BP against placebo treatment, with a minimum 12 months follow-up, were included. Risk ratios (RR) and 95% CIs were calculated using a random effects model. The primary outcome was RR of major cardiovascular events (MCEs); secondary outcomes included myocardial infarction (MI), stroke, heart failure (HF), cardiovascular (CV) mortality, and all-cause mortality. We included 16 studies totaling 65,890 hypertensive participants (average age 69.4 years) with a follow-up period from 1.8 to 4.9 years. Intensive BP treatment significantly reduced the relative risk of MCEs by 26% (RR:0.74, 95%CI 0.64–0.86, p = 0.000; I2 = 79.71%). RR of MI significantly reduced by 13% (RR:0.87, 95%CI 0.76–1.00, p = 0.052; I2 = 0.00%), stroke by 28% (RR:0.72, 95%CI 0.64–0.82, p = 0.000; I2 = 32.45%), HF by 47% (RR:0.53, 95% CI 0.43–0.66, p = 0.000; I2 = 1.23%), and CV mortality by 24% (RR:0.76, 95%CI 0.66–0.89, p = 0.000; I2 = 39.74%). All-cause mortality reduced by 17% (RR:0.83, 95%CI 0.73–0.93, p = 0.001; I2 = 53.09%). Of the participants - 61% reached BP targets and 5% withdrew; with 1 hypotension-related event per 780 people treated. Lower BP treatment targets are optimal for CV protection, effective, well-tolerated and safe, and support the latest hypertension guidelines.
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Baffour-Awuah et al. (2020) conducted a meta-analysis in Hypertension (n=65,890). Intensive blood pressure treatment vs. Standard blood pressure treatment (with or without placebo) was evaluated on Major cardiovascular events (MCEs) (RR 0.74, 95% CI 0.64-0.86, p=0.000). Intensive blood pressure treatment significantly reduced the relative risk of major cardiovascular events by 26% (RR 0.74) compared to standard treatment in hypertensive older adults.
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