Key result
Intensive SBP control reduced cardiovascular events (HR 0.66; 95% CI 0.49-0.90) and mortality in adults ≥80 years, though benefits were limited to those with higher baseline cognitive function.
Why the study?
The study was conducted to evaluate the effect of intensive SBP control in older adults with hypertension, considering cognitive and physical function.
Does intensive systolic blood pressure control to a target below 120 mm Hg reduce cardiovascular events, mortality, and cognitive impairment in adults aged 80 years or older with hypertension but without diabetes?
RCT (n=1,167)
randomized
Does intensive systolic blood pressure control to a target below 120 mm Hg reduce cardiovascular events, mortality, and cognitive impairment in adults aged 80 years or older with hypertension but without diabetes?
Intensive blood pressure control (<120 mm Hg) in adults ≥80 years reduces cardiovascular events, mortality, and mild cognitive impairment, though benefits may be limited to those with higher baseline cognitive function and come with increased risk of kidney function decline.
Answers are grounded in this paper and cite their sources.
Supports intensive SBP targets in cognitively intact adults ≥80 years; extends SPRINT findings while identifying cognitive status as an effect modifier.
OBJECTIVES: To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function. DESIGN: Secondary analysis. SETTING: Systolic Blood Pressure Intervention Trial (SPRINT) PARTICIPANTS: Adults 80 years or older. INTERVENTION: Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment). MEASUREMENTS: We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4-m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function. RESULTS: Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49-.90), mortality (HR = .67; 95% CI = .48-.93), and MCI (HR = .70; 95% CI = .51-.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28-.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87-2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between-group differences in the rate of injurious falls. CONCLUSION: In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01206062. J Am Geriatr Soc 68:496-504, 2020.
No takes yet. Share an insight, caveat, or question.
Pajewski et al. (2019) conducted an RCT in hypertension (n=1,167). Intensive systolic blood pressure control vs. standard treatment (target below 140 mm Hg) was evaluated on cardiovascular events (HR 0.66, 95% CI 0.49-0.90). Intensive SBP control reduced cardiovascular events (HR 0.66; 95% CI 0.49-0.90) and mortality in adults ≥80 years, though benefits were limited to those with higher baseline cognitive function.
Synapse has enriched 10 related papers. Consider them for comparative context: