Target Blood Pressure for Treatment of Isolated Systolic Hypertension in the Elderly

Abstract

Abstract-In this prospective, randomized, open-label, blinded end point study, we aimed to establish whether strict blood pressure control (Ͻ140 mm Hg) is superior to moderate blood pressure control (Ն140 mm Hg to Ͻ150 mm Hg) in reducing cardiovascular mortality and morbidity in elderly patients with isolated systolic hypertension. We divided 3260 patients aged 70 to 84 years with isolated systolic hypertension (sitting blood pressure 160 to 199 mm Hg) into 2 groups, according to strict or moderate blood pressure treatment. A composite of cardiovascular events was evaluated for Ն2 years. The strict control (1545 patients) and moderate control (1534 patients) groups were well matched (mean age: 76.1 years; mean blood pressure: 169.5/81.5 mm Hg). Median follow-up was 3.07 years. At 3 years, blood pressure reached 136.6/74.8 mm Hg and 142.0/76.5 mm Hg, respectively. The blood pressure difference between the 2 groups was 5.4/1.7 mm Hg. The overall rate of the primary composite end point was 10.6 per 1000 patient-years in the strict control group and 12.0 per 1000 patient-years in the moderate control group (hazard ratio: 0.89; [95% CI: 0.60 to 1.34]; Pϭ0.38). In summary, blood pressure targets of Ͻ140 mm Hg are safely achievable in relatively healthy patients Ն70 years of age with isolated systolic hypertension, although our trial was underpowered to definitively determine whether strict control was superior to less stringent blood pressure targets. Key Words: isolated systolic hypertension Ⅲ elderly Ⅲ blood pressure Ⅲ prognosis Ⅲ valsartan H igh blood pressure (BP) is well known to be a major risk factor for cardiovascular events, such as stroke and myocardial infarction, 1 and linear relationships between cardiovascular risk and both systolic and diastolic BPs, unrelated to age, have also been reported based on a meta-analysis of large cohort studies conducted worldwide. 2 In particular, systolic BP predominantly affects cardiovascular events in elderly people. 3 Numerous large clinical trials, such as the Systolic Hypertension in the Elderly Program, 4 Swedish Trial in Old Patients, 5 Medical Research Council, 6 Systolic Hypertension in Europe, 7 and Systolic Hypertension in China, 8 have provided evidence of the benefits of reducing BP in the elderly. Meta-analysis of clinical trials showed that treatment of hypertension in older adults is as beneficial as that in younger adults. 9 A recent study performed in hypertensive patients aged Ն80 years of age, the Hypertension in the Very Elderly Trial, showed that antihypertensive treatment is beneficial to reduce the risks of death from stroke, death from any cause, and heart failure. 10 These observations indicate that antihypertensive treatment is beneficial even in very elderly patients.To reduce cardiovascular risks, in general BP should be kept as low as possible based on evidence from numerous clinical trials and epidemiological data. 11 On the other hand, several epidemiological studies in the elderly, such as Vantaa and Leinden 85-Plus, reported a poor progno...

Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

“…Our sample size estimates, based on the Ohasama population, 22 assumed a rate of the primary end point in the control group of 13.0 events per 1000 patient-years, whereas it ran at only 2.96 events per 1000 patient-years in the 2 treatment groups combined. Lower than expected rates of the primary end point also occurred in several other trials conducted by Japanese 30 or International 31 Research Consortia.…”

Treatment Intensification for Hypertension in US Ambulatory Medical Care

“…We observed lower prevalence and odds of treatment intensification in older adults; this may result from a relative lack of evidence supporting a goal SBP less than 150 mm Hg in the elderly28, 29 until the recent SPRINT results 15, 16. In contrast, for people with diabetes mellitus, a goal SBP/DBP of 130/80 mm Hg was recommended in 2003,12 and yet treatment intensification from 2005 to 2012 among diabetic adults remained low even compared to those without diabetes mellitus.…”

Prevalence of cardiovascular risk factors among rural population of elderly in Wardha district

“…There is a need for sustained provider level education, that elderly are not any different from young. Control of blood pressure among elderly has been shown to be safe and beneficial, 26,27 and various guidelines have reaffirmed that except for frail elderly, and all must achieve optimum control. 28e30 While innovative hypertension treatment programs for rural elderly have been initiated in middle income countries such as China 31 and Korea, 32 there is a need for such an initiative in India.…”