Key result
Intensive SBP control cuts cardiovascular risk ~39% versus standard treatment.
Why the study?
Intensive systolic blood pressure lowering is increasingly used, but data are missing on patients who achieve their target blood pressure.
Does achieving an intensive SBP target (110 to <130 mmHg) reduce cardiovascular events compared to achieving a standard SBP target (130 to <150 mmHg) in hypertensive patients aged 60-80 years?
RCT (n=8,511)
Yes
Does achieving an intensive SBP target (110 to <130 mmHg) reduce cardiovascular events compared to achieving a standard SBP target (130 to <150 mmHg) in hypertensive patients aged 60-80 years?
Achieving and maintaining an intensive SBP target of <130 mmHg provides significant cardiovascular benefits over standard targets in older hypertensive patients.
Answers are grounded in this paper and cite their sources.
Supports intensive SBP targets (<130 mmHg) in hypertensives aged 60-80; reinforces benefits from prior randomized trials.
AIMS: Intensive systolic blood pressure (SBP) lowering has been increasingly used; however, data is missing on patients who had target-achieved (TA). This study aims to show the cardiovascular effect of maintaining SBP at intensive levels. METHODS: The Strategy of Blood Pressure Intervention in Elderly Hypertensive Patients (STEP) trial was a multicentre, randomized, controlled trial which enrolled 8511 young-older (60-80 years) hypertensive patients without prior stroke to compare the cardiovascular prognosis of the intensive treatment (SBP target, 110 to <130 mmHg) vs. the standard treatment (130 to <150 mmHg). This secondary analysis assessed data in patients who achieved a mean SBP within target values. The association of mean achieved SBP and cardiovascular events was examined using a cubic spline function. RESULTS: In total, 3053 patients (72.0%) in the intensive-treatment group and 3427 (80.3%) in the standard-treatment group had an SBP target achieved, with mean follow-up SBP values of 124.2 mmHg and 137.4 mmHg, respectively. Throughout the median 3.38-year follow-up, the cardiovascular risk was significantly lower in the TA intensive-treatment group than in the TA standard-treatment group [adjusted hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.46-0.80; P < 0.001]. In the intensive-treatment group, patients failing to achieve SBP targets presented higher cardiovascular risk than those TA patients (HR 2.04, 95% CI 1.44-2.88; P < 0.001). A J-shaped relationship was observed between the mean achieved SBP and risk of cardiovascular events, with the lowest risk at an SBP of 126.9 mmHg. CONCLUSIONS: Maintaining SBP at <130 mmHg offers additional cardiovascular benefits among young-older patients with hypertension. REGISTRATION: ClinicalTrials.gov: NCT03015311.
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Deng et al. (2023) conducted an RCT in Hypertension (n=8,511). Intensive SBP lowering (target 110 to <130 mmHg) vs. Standard SBP lowering (target 130 to <150 mmHg) was evaluated on Cardiovascular events (HR 0.61, 95% CI 0.46-0.80, p=< 0.001). Maintaining systolic blood pressure at intensive levels (<130 mmHg) significantly lowered cardiovascular risk compared to standard treatment (HR 0.61; 95% CI 0.46-0.80; P<0.001).
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