Key result
A review of trials found contradictory evidence on optimal blood pressure targets for geriatric stroke survivors, with some data suggesting SBP <120 mm Hg increases re-stroke risk compared to 130-139 mm Hg.
Why the study?
Lowering blood pressure prevents stroke, but evidence regarding optimal target blood pressure levels in patients with hypertension and history of cerebral events, particularly geriatric patients, needed review.
Does intensive blood pressure lowering prevent re-stroke and cardiovascular events in geriatric patients with a history of stroke?
Does intensive blood pressure lowering prevent re-stroke and cardiovascular events in geriatric patients with a history of stroke?
The optimal target blood pressure for secondary stroke prevention in geriatric patients remains uncertain, highlighting the need for dedicated trials in older, frail, and multimorbid populations.
Intensive SBP targets should not yet change practice in geriatric stroke survivors; leaves open dedicated trials in older, frail patients.
Arterial hypertension (AH) is a very significant and most common risk factor for stroke, and lowering blood pressure (BP) is the most effective action to prevent stroke in patients with AH. This article provides an overview of existing randomized clinical trials (RCTs) and meta-analyzes to study the optimal target BP levels in patients with AH and cerebral events with a history of focusing on the geriatric population. As a result of the analysis of literature data, we obtained contradictory results: RCTs showed the benefits of lower target BP, in only two of them the target level of systolic BP (SBP) was less than 130 mm Hg, and the average age of patients included in the RCTs varied from 60 to 68 years, the number of patients older than 75 years was insignificant, and some studies excluded patients older than 85 years. Several subanalyses analyzed by RCTs found a J-shaped relationship between BP levels achieved and the risk of adverse cardiovascular events. One of them showed that with a decrease in BP below the SBP 120 mm Hg and DBP 65 mm Hg higher BP was associated with a lower risk of cardiovascular events. Another one showed that the risk of re-stroke and the risk of subsequent adverse events was statistically significantly higher in patients with an average level of SBP below 120 mm Hg than in patients with a level of SBP of 130139 mm Hg. The meta-analysis published in the Cochrane database did not show significant advantages of lowering BP130/85 mm Hg versus standard lowering BP140160/90100 mm Hg, while another meta-analysis revealed some advantages of a more intense decrease in BP for the prevention of re-stroke. Existing studies did not take into account the heterogeneity of the geriatric population and did not include patients with fraility and multimorbidity patients, and did not take into account the type of stroke to develop a differentiated approach to the tactics of lowering BP in patients of all age groups. Therefore, in relation to the recommended ESC/ESH experts in 2018, target BP levels of 120129/7079 mm Hg (aged 1865 years) and 130139/7079 mmHg (aged 65 years) for patients with AH and a history of cerebral events, there are still some doubts about the benefits of lower target BP values for the prevention of re-stroke and other cardiovascular events for the entire population of geriatric patients, especially patients older than 75, so specially designed randomized controlled trials are needed.
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Остроумова et al. (2020) conducted a review in Arterial hypertension and history of stroke in a geriatric population. Lower target blood pressure vs. Standard target blood pressure was evaluated. A review of trials found contradictory evidence on optimal blood pressure targets for geriatric stroke survivors, with some data suggesting SBP <120 mm Hg increases re-stroke risk compared to 130-139 mm Hg.
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