Key result
Intensive SBP lowering cuts major cardiovascular events ~26% vs standard care in adults ≥75.
Why the study?
Intensive SBP treatment reduces cardiovascular events in older adults, but it remained uncertain whether its benefits outweigh treatment-related harms in late life.
Does intensive systolic blood pressure lowering (<120 or <130 mm Hg) provide a favorable net clinical benefit (reducing major cardiovascular events relative to treatment-related adverse events) compared to standard treatment in adults aged 75 years or older?
Meta-Analysis (n=8,997)
Randomized controlled trials
Yes
Does intensive systolic blood pressure lowering (<120 or <130 mm Hg) provide a favorable net clinical benefit (reducing major cardiovascular events relative to treatment-related adverse events) compared to standard treatment in adults aged 75 years or older?
In adults aged 75 years and older (including those ≥80 years), intensive systolic blood pressure lowering yields a favorable net clinical benefit where reductions in major cardiovascular events outweigh the increased risks of total and renal adverse events.
Answers are grounded in this paper and cite their sources.
Intensive SBP targets reduce cardiovascular events in older adults; confirms net benefit and supports guideline-directed tighter control.
Background: Intensive systolic blood pressure (SBP) treatment reduces cardiovascular events in older adults, but whether its benefits outweigh treatment-related harms in late life remains uncertain. Methods: We conducted a one-stage individual participant data meta-analysis of 6 randomized controlled trials (ACCORD BP, SPRINT, ESPRIT, BPROAD, STEP, and CRHCP) comparing intensive SBP targets (<120 or <130 mm Hg) with standard treatment. Eligible trials met 5 predefined criteria: intensive vs standard SBP treatment, reporting of composite major cardiovascular events, enrollment of more than 2000 participants, standardized adverse event reporting, and availability of individual participant data. The primary benefit outcome was major cardiovascular events, defined as myocardial infarction, stroke, heart failure, or cardiovascular death. The primary harm outcome was total adverse events (eg, hypotension, syncope); renal adverse events were also analyzed. Data were analyzed using Bayesian hierarchical models. Net benefit was absolute risk reduction (ARR) minus weighted absolute risk increase (ARI), using prespecified weights of 1.0:3.1 for total adverse events and 1.0:1.8 for renal adverse events. Adults aged 80 years or older were analyzed as a subgroup. Results: Among 8997 participants (mean [SD] age, 78.7 [3.4] years), 4414 were assigned to intensive SBP treatment and 4583 to standard SBP treatment. During a median follow-up of 3.0 years, major cardiovascular events occurred in 347 participants (7.9%) in the intensive SBP treatment group and 479 participants (10.5%) in the standard SBP treatment group (adjusted hazard ratio, 0.74 [95% credible interval (CrI), 0.65-0.85]; ARR, 2.4% [95% CrI, 2.3%-2.6%]). Compared with standard SBP treatment, intensive SBP treatment was associated with a 2.3% ARI (95% CrI, 2.1%-2.4%) for total adverse events and a 1.7% ARI (95% CrI, 1.6%-1.8%) for renal adverse events. Overall, intensive SBP treatment showed a favorable net benefit of 1.72% (95% CrI, 1.54%-1.90%) considering total adverse events and 1.49% (95% CrI, 1.30%-1.67%) considering renal adverse events. Among participants aged 80 years or older, net benefit remained positive when accounting for total adverse events (0.60% [95% CrI, 0.36%-0.91%]) and renal adverse events (0.28% [95% CrI, 0.03%-0.58%]). Conclusions: Among adults aged 75 years or older, intensive SBP treatment provides a favorable net clinical benefit after integrating reduced cardiovascular risk with increased adverse event risk, with consistent exploratory findings among participants aged 80 years or older, supporting intensive SBP management in late life.
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Chen et al. (2026) conducted a meta-analysis in Hypertension in older adults (n=8,997). Intensive systolic blood pressure treatment vs. Standard systolic blood pressure treatment was evaluated on Major cardiovascular events (myocardial infarction, stroke, heart failure, or cardiovascular death) (HR 0.74, 95% CI 0.65-0.85). Intensive SBP lowering in adults ≥75 years reduced major cardiovascular events vs standard care (7.9% vs 10.5%; HR 0.74, 95% CrI 0.65-0.85) with a 1.72% net benefit.
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