Key result
Intensive BP treatment could avert ~380,000 annual deaths among eligible elderly in the US and China.
Why the study?
Clinical benefits of intensive blood pressure treatment were shown in SPRINT and STEP, but data on generalisability and potential implications of scaling up treatment to all eligible elderly adults were limited.
What is the generalisability of intensive blood pressure treatment criteria (SPRINT and STEP) and how many deaths could be averted among the elderly in the US and China?
Cross-Sectional
Yes
What is the generalisability of intensive blood pressure treatment criteria (SPRINT and STEP) and how many deaths could be averted among the elderly in the US and China?
A substantial proportion of elderly adults in the US and China are eligible for intensive blood pressure treatment, the implementation of which could avert hundreds of thousands of deaths annually.
May guide eligibility estimates for intensive BP treatment in elderly adults; leaves open whether projections translate to real-world mortality reductions.
Background: The Systolic Blood Pressure Intervention Trial (SPRINT) from the US and the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial from China have consistently demonstrated clinical benefits from intensive blood pressure (BP) treatment among elderly adults with hypertension. However, we have little data on the generalisability and potential implications of a scale-up of intensive BP treatment to all eligible elderly in the US and China. Methods: We used two nationally representative data sets from China (Health and Retirement Longitudinal Study (CHALRS), 2011-2012) and the US (National Health and Nutrition Examination Survey (NHANES), 2007-2012) and linked them with CHARLS follow-up data (2013) and the National Death Index (1999-2015), respectively. We estimated the percentage, number, and characteristics of elderly (≥60 years old) meeting the STEP and SPRINT eligibility criteria, and deaths that would be prevented or postponed with the implementation of intensive BP treatment. Results: Among the Chinese adults aged 60 years and over, 38.89% (95% confidence interval (CI) = 36.97-40.84) or 85.39 (95% CI = 81.14-89.64) million subjects met the STEP criteria, and 40.90 million (47.90%) adults were not taking antihypertensive medications. In the US, 23.77% (95% CI = 22.32%-25.28) or 12.46 (95% CI = 11.68-13.24) million elderly were eligible for the SPRINT, and 5.78 million (46.36%) were untreated. Overall, 0.07 (95% CI = 0.06-0.08) million deaths in the US and 0.31 (95% CI = 0.25-0.39) in China would be averted annually if intensive BP treatment was implemented, while 120 000 and 680 000 of hypotension cases would be identified yearly inthe US and China, respectively. Conclusions: A substantial percentage of Chinese and the US elderly meet the eligibility criteria for STEP and SPRINT. If intensive BP treatment was adopted, 70 000 and 310 000 deaths would be prevented or postponed yearly in the US and China, respectively.
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Li et al. (2023) conducted a cross-sectional in Hypertension. Intensive blood pressure treatment was evaluated on Number of eligible elderly and potential deaths averted annually. Implementing intensive blood pressure treatment among eligible elderly adults could avert approximately 70,000 deaths annually in the US and 310,000 deaths annually in China.
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