Related Experiment Video
Updated: Jan 23, 2026
In Silico Clinical Trials for Cardiovascular Disease
Published on: May 27, 2022
Treatment of hypertension in old patients without previous cardiovascular disease
Johan-Emil Bager1,2, Per Hjerpe3,4, Karin Manhem1,2
1Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
Insights
Lower blood pressure than recommended may benefit older patients by reducing cardiovascular disease (CVD) risk. This study found that systolic blood pressure levels of 110-129 mmHg were associated with a lower incidence of CVD in older individuals.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- Current hypertension guidelines recommend specific blood pressure targets.
- The optimal blood pressure in older adults, particularly those with hypertension, remains an area of investigation.
- Previous studies have yielded conflicting results regarding the benefits of lower blood pressure in elderly populations.
Purpose of the Study:
- To compare the risk of cardiovascular disease (CVD), including nonfatal acute myocardial infarction (AMI) and stroke, at blood pressure levels meeting current recommendations versus lower levels.
- To specifically investigate this risk in older patients (aged 76-90 years).
Main Methods:
- A cohort of 31,704 hypertensive patients aged 40-90 years was identified from a primary care register.
- Patients with a history of cancer, diabetes mellitus, or CVD were excluded.
- Systolic blood pressure (SBP) was categorized into four groups: 110-129, 130-139 (reference), 140-149, and ≥150 mmHg.
- Kaplan-Meier and Cox proportional-hazards regression analyses were used to assess the incidence of AMI, stroke, and a composite CVD outcome.
Main Results:
- In older patients (76-90 years), SBP levels of 110-129 mmHg were associated with the lowest risk of CVD.
- The incidence of CVD in this lower SBP group was 15.9/1000 person-years compared to 25.3/1000 person-years in the reference group (130-139 mmHg).
- Adjusted hazard ratio for CVD in older patients with SBP 110-129 mmHg was 0.60 (95% CI 0.40-0.92) compared to the reference group.
Conclusions:
- Blood pressure levels below current recommendations do not appear to be harmful in older hypertensive patients.
- Lower systolic blood pressure in older adults may be associated with a reduced risk of cardiovascular disease.
- These findings suggest a potentially beneficial effect of lower SBP in the elderly population.
Objective:
The aim of this study was to compare the risk of cardiovascular disease (CVD) - nonfatal acute myocardial infarction (AMI) or stroke - at blood pressure levels that meet current recommendations with risk at lower levels, particularly in older patients.
Methods:
We identified patients with hypertension aged 40-90 years from a primary care register. Patients with a history of cancer, diabetes mellitus or CVD were excluded. Patients were divided into age groups (40-75 and 76-90), and four groups of SBP 110-129, 130-139 (reference), 140-149 and ≥150 mmHg. We used the Kaplan-Meier estimator to study incidence of AMI, stroke and a composite of the two. Cox proportional-hazards regression was used to estimate hazard ratios for outcomes.
Results:
We included 31 704 patients: 26 663 were 40-75 years old and 5041 were 76-90 years old. Mean follow-up was 2 years. Although no significant differences in risk of any outcome were found in the younger group, low blood pressure was associated with the lowest risk in the older group. Older patients in the 110-129 mmHg group had a lower incidence of CVD (15.9/1000 vs. 25.3/1000 person-years) than the reference group. After adjustment for covariates, the hazard ratio of CVD in older patients in the 110-129 mmHg group compared with the reference group was 0.60 (95% confidence interval 0.40-0.92).
Conclusion:
Blood pressure levels lower than those currently recommended are not harmful among older patients. The association between lower SBP and lesser risk of CVD may instead suggest a beneficial effect of lower SBP.
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