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.
Why the study?
Hypertension is common in the elderly and tied to substantial morbidity and mortality, but the optimal target for blood pressure control remains controversial.
Does intensive blood pressure control improve cardiovascular outcomes and mortality without increasing adverse events in elderly patients aged 70 years or older?
Does intensive blood pressure control improve cardiovascular outcomes and mortality without increasing adverse events in elderly patients aged 70 years or older?
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.
May support lower SBP targets in adults ≥70 without excess harm; leaves open need for dedicated RCTs.
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.
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Alsarah et al. (2019) conducted a review in Hypertension. Intensive blood pressure control (SBP <150 mmHg or <120 mmHg) vs. Standard blood pressure control was evaluated. 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.
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