Key result
Lowering systolic blood pressure to 140 mmHg was projected to prevent more events and save more money than a 150 mmHg target in secondary prevention and fast-walking primary prevention adults.
Why the study?
Does lowering SBP to a target of 140 mmHg compared to 150 mmHg improve clinical outcomes and cost-effectiveness in older adults stratified by gait speed?
Does lowering SBP to a target of 140 mmHg compared to 150 mmHg improve clinical outcomes and cost-effectiveness in older adults stratified by gait speed?
The optimal and most cost-effective systolic blood pressure target in older adults varies significantly based on their history of cardiovascular disease and baseline gait speed.
May support 140 mmHg SBP targets in secondary prevention and fast-walking older adults; hypothesis-generating and requires prospective validation.
OBJECTIVES: To evaluate the potential for gait speed to inform decisions regarding optimal systolic blood pressure targets in older adults. DESIGN: Forecasting study from 2014 to 2023 using the Cardiovascular Disease Policy Model, a Markov model. SETTING: National Health and Nutrition Examination Survey. PARTICIPANTS: U.S. adults aged 60-94 stratified into fast walking, slow walking, and poor functioning (noncompleters) based on measured gait speed. MEASUREMENTS: Lowering SBP to a target of 140 or 150 mmHg was modeled in persons with (secondary prevention) and without (primary prevention) a history of coronary heart disease or stroke. Based on clinical trials and observational studies, it was projected that slow-walking and poor-functioning participants would have greater noncardiovascular mortality. Myocardial infarctions (MIs), strokes, deaths, cost, and disability-adjusted life years (DALYs) were measured. RESULTS: Regardless of gait speed, it was projected that secondary prevention to a systolic blood pressure (SBP) of 140 mmHg would prevent more events and save more money than secondary prevention to 150 mmHg. Similarly, primary prevention to 140 mmHg in fast-walking adults was projected to prevent events and save money. In slow-walking adults, primary prevention to 150 mmHg was projected to prevent MIs and strokes and save DALYs but was cost saving only in men; intensification to 140 mmHg is of uncertain benefit in slow-walking individuals. Primary prevention in poor-functioning adults to a target of 140 or 150 mmHg SBP is projected to decrease DALYs. CONCLUSION: The most cost-effective SBP target varies according to history of cardiovascular disease and gait speed in persons aged 60-94. These projections highlight the need for better estimates of the benefits and harms of antihypertensive medications in a diverse group of older adults, because the net benefit is sensitive to the characteristics of the population treated.
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Odden et al. (2016) studied Hypertension. Systolic blood pressure target of 140 mmHg vs. Systolic blood pressure target of 150 mmHg was evaluated on Myocardial infarctions, strokes, deaths, cost, and disability-adjusted life years. Lowering systolic blood pressure to 140 mmHg was projected to prevent more events and save more money than a 150 mmHg target in secondary prevention and fast-walking primary prevention adults.
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