Achieved home systolic blood pressure and cardiovascular risk in older hypertensive patients

Intensive blood pressure treatment reduces cardiovascular events, but the optimal achieved home systolic blood pressure (SBP) level for older patients with hypertension remains uncertain. This secondary analysis was based on data from the Strategy of Blood Pressure Intervention in Older Hypertensive Patients trial. Morning and evening home blood pressure measurements obtained between 3 and 12 months after enrollment were used to calculate the achieved home SBP. Participants were then categorized into four achieved home SBP groups: <125 mmHg, 125–130 mmHg, 130–135 mmHg, and ≥135 mmHg. The primary outcome was a composite of cardiovascular events. Among 7681 participants included in this analysis, 261 primary events occurred during the median follow-up of 3.43 years. Compared with home SBP ≥ 135 mmHg, the absolute risk reduction for the primary composite outcome was 1.70% in the <125 mmHg group, 1.36% in the 125–130 mmHg group. In multivariable analyses, home SBP < 125 mmHg and 125–130 mmHg were associated with lower risks of the primary composite outcome, with adjusted HRs of 0.62 (95% CI, 0.42–0.90) and 0.66 (95% CI, 0.47–0.94), respectively. Similar protective associations were observed for stroke (adjusted HR, 0.36; 95% CI, 0.19–0.66). Lower home SBP categories were not associated with a statistically significant increase in the primary safety outcome. These findings suggest that achieving home SBP below 130 mmHg, and further approaching 125 mmHg in selected patients with a high risk of stroke and good treatment tolerance, may provide additional cardiovascular benefit beyond the conventional threshold.