Key result
Among older adults, achieving systolic blood pressure levels of 130 to <140 mmHg was associated with a 28% lower risk of cardiovascular mortality compared to levels ≥140 mmHg in post-hoc analyses of RCTs.
Why the study?
Does achieving specific SBP levels <150 mmHg reduce cardiovascular events and mortality in subjects aged ≥60 years old receiving antihypertensive drug treatment?
Meta-Analysis (n=33,600)
Does achieving specific SBP levels <150 mmHg reduce cardiovascular events and mortality in subjects aged ≥60 years old receiving antihypertensive drug treatment?
Relative Risk: 0.72 (95% CI 0.59–0.88)
Among older people, achieving SBP levels of 130 to <140 mmHg is suggestively associated with lower risks of cardiovascular and all-cause mortality compared to ≥140 mmHg.
Supports SBP 130-<140 mmHg targets in older adults; extends post-hoc RCT meta-analyses but remains hypothesis-generating.
BACKGROUND: It remains unclear into which level the systolic blood pressure (SBP) should be lowered in order to provide the best cardiovascular protection among older people. Hypertension guidelines recommendation on attaining SBP levels <150 mmHg in this population is currently based on experts' opinion. To clarify this issue, we systematically reviewed and quantified available evidence on the impact of achieving different SBP levels <150 mmHg on various adverse outcomes in subjects aged ≥60 years old receiving antihypertensive drug treatment. METHODS: We searched 8 databases to identify randomized controlled trials (RCTs) and post-hoc analyses or subanalyses of RCTs reporting the effects of attaining different SBP levels <150 mmHg on the risk of stroke, acute myocardial infarction, heart failure, cardiovascular mortality and all-cause mortality in participants aged ≥60 years. We performed random-effects meta-analyses stratified by study design. RESULTS: Eleven studies (> 33,600 participants) were included. Compared with attaining SBP levels ≥140 mmHg, levels of 130 to <140 mmHg were not associated with lower risk of outcomes in the meta-analysis of RCTs, whereas there was an associated reduction of cardiovascular mortality (RR 0.72, 95% CI 0.59-0.88) and all-cause mortality (RR 0.86, 95% CI 0.75-0.99) in the meta-analysis of post-hoc analyses or subanalyses of RCTs. Limited and conflicting data were available for the SBP levels of <130 mmHg and 140 to <150 mmHg. CONCLUSIONS: Among older people, there is suggestive evidence that achieving SBP levels of 130 to <140 mmHg is associated with lower risks of cardiovascular and all-cause mortality. Future trials are required to confirm these findings and to provide additional evidence regarding the <130 and 140 to <150 mmHg SBP levels.
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Moraes et al. (2017) conducted a meta-analysis in Hypertension (n=33,600). Achieving SBP levels of 130 to <140 mmHg vs. Achieving SBP levels ≥140 mmHg was evaluated on Cardiovascular mortality (meta-analysis of post-hoc analyses or subanalyses of RCTs) (RR 0.72, 95% CI 0.59-0.88). Among older adults, achieving systolic blood pressure levels of 130 to <140 mmHg was associated with a 28% lower risk of cardiovascular mortality compared to levels ≥140 mmHg in post-hoc analyses of RCTs.
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