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Strategy of blood pressure intervention in the elderly hypertensive patients (STEP): Rational, design, and baseline

Shuyuan Zhang1, Shouling Wu2, Jie Ren3

  • 1State Key Laboratory of Cardiovascular Disease, Hypertension Center, FuWai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100037, China.

Contemporary Clinical Trials
|December 16, 2019
PubMed

Insights

The STEP trial investigates intensive versus standard blood pressure treatment targets in older adults with hypertension. It also assesses the effectiveness of smartphone app management for improving blood pressure control.

Area of Science:

  • Cardiology
  • Geriatrics
  • Clinical Trials

Background:

  • Optimal systolic blood pressure (SBP) treatment targets for elderly individuals remain a challenge.
  • Patient non-adherence is a significant factor contributing to uncontrolled hypertension.
  • The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial addresses these issues.

Purpose of the Study:

  • To compare the benefits of intensive SBP treatment (110–129 mmHg) versus standard treatment (130–149 mmHg) on cardiovascular events in hypertensive patients aged 60-80 years.
  • To evaluate the efficacy of smartphone app-based management in controlling blood pressure compared to usual care.
  • To provide evidence for optimal BP control targets and management strategies in the elderly.

Main Methods:

  • A multi-center, randomized controlled trial involving 8511 patients with primary hypertension in China.
  • Participants were randomized 1:1 to intensive or standard BP treatment groups, stratified by clinical site.
  • A secondary objective involved randomizing hospitals to smartphone app or usual care groups to assess app management effectiveness.
  • Standardized, validated home and office BP devices with automatic data upload were used.

Main Results:

  • The study recruited 8511 patients aged 60-80 years, with a mean age of 66.2 years.
  • 24.1% of participants were in the 70-80 year age range.
  • 65% of participants were classified as high-risk based on a 10-year Framingham risk score ≥ 15%.

Conclusions:

  • The STEP trial will offer crucial evidence regarding the appropriate SBP treatment target for hypertensive individuals aged 60-80 years.
  • Findings will inform the development of effective hypertension management models, including the use of mobile health applications.
  • The study aims to reduce cardiovascular events by optimizing blood pressure management in the elderly population.

Keywords:
Essential hypertensionMajor adverse cardiovascular eventsMobile applicationsRandomized clinical trialSystolic blood pressure

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