Key result
In hypertensive patients aged 75 years or older with multiple risk factors, an on-treatment systolic blood pressure of 145-154 mm Hg increased all-cause mortality by 4.6 per 1000 person-years compared to 125-134 mm Hg.
Why the study?
It remains unclear what the blood pressure target is and at which point in life antihypertensive treatment is appropriate.
Does the optimal systolic blood pressure target for preventing cardio-kidney events, dementia, and mortality differ by age and baseline risk factors in hypertensive patients?
Cohort (n=555,498)
Yes
Does the optimal systolic blood pressure target for preventing cardio-kidney events, dementia, and mortality differ by age and baseline risk factors in hypertensive patients?
Effect estimate: Rate difference 4.6 per 1000 person-years (95% CI 2.0-7.3)
Blood pressure targets can be relaxed in very old patients and those with few risk factors, but strict control remains beneficial for older patients with multiple cardiovascular risk factors.
It remains unclear what the blood pressure target is and at which point in life it is appropriate for antihypertensive treatment. This study aimed to determine age-specific systolic blood pressure (SBP) targets. In a nationwide cohort of 296,470 hypertensive patients aged ≥75 years and a representative cohort of 259,028 hypertensives aged 45-74 years, multivariable-adjusted incidence rates of cardio-kidney composite events, overt dementia, and all-cause deaths were estimated across yearly-averaged on-treatment SBP levels according to age and the presence of 4 additional risk factors (diabetes, dyslipidemia, albuminuria, and smoking). For cardio-kidney events, on-treatment SBP showed positive curvilinear associations with higher risks at ≥135 mm Hg in most while an attenuated association in age ≥85 years. For overt dementia, SBP showed flat or slightly inverted associations in elderly while a small positive association in age 45-64 years. For all-cause mortality, SBP showed J-shaped associations having right-shifting tendency with age. For risk categories with ≥2, 1, and no additional risk factors, the respective mortality rate differences between SBP 145-154 mm Hg and 125-134 mm Hg were 4.6 (95% confidence interval [CI], 2.0 to 7.3), 1.2 (95% CI, -0.3 to 2.8), and 0.1 (95% CI, -1.4 to 1.8) per 1000 person-years in age ≥75 years and 2.9 (95% CI, 1.7 to 4.3), 0.7 (95% CI, 0.1 to 1.4), and 0.9 (95% CI, 0.2 to 1.6) per 1000 person-years in age 45-74 years. In conclusion, the BP target can be relaxed in very old patients and in elderly patients with few risk factors. However, strict BP control may be needed in patients with multiple risk factors even in those with advanced age.
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Hae Hyuk Jung (2024) conducted a cohort in Hypertension (n=555,498). On-treatment systolic blood pressure targets vs. 125-134 mm Hg was evaluated on All-cause mortality rate difference (in patients ≥75 years with ≥2 additional risk factors) (Rate difference 4.6 per 1000 person-years, 95% CI 2.0-7.3). In hypertensive patients aged 75 years or older with multiple risk factors, an on-treatment systolic blood pressure of 145-154 mm Hg increased all-cause mortality by 4.6 per 1000 person-years compared to 125-134 mm Hg.
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