What we learned from STEP that we didn't already know from SPRINT

Area of Science:

• Gerontology
• Cardiology
• Nephrology

Background:

• The aging population presents challenges in managing hypertension targets for elderly individuals.
• Optimizing treatment goals for hypertension in older adults is a significant clinical concern.

Purpose of the Study:

• To evaluate the efficacy of intensive blood pressure treatment in elderly Chinese hypertensive patients.
• To compare cardiovascular outcomes between intensive and standard blood pressure targets in the STEP study population.

Main Methods:

• The STEP study enrolled hypertensive Chinese patients aged 60-80 years, excluding those with prior stroke.
• Participants were assigned to intensive blood pressure treatment aiming for a systolic target of 110-130 mmHg.
• The STEP population had lower cardiovascular risk and chronic kidney disease (CKD) prevalence compared to the SPRINT study.

Main Results:

• Intensive blood pressure treatment significantly reduced the composite cardiovascular endpoint and stroke incidence.
• No significant effect was observed on cardiovascular death or renal harm.
• These findings contrast with the SPRINT study, where these endpoints were significantly affected.

Conclusions:

• Intensive blood pressure management in elderly Chinese hypertensive patients effectively lowers cardiovascular events and stroke risk.
• The distinct outcomes compared to SPRINT are attributed to the lower cardiovascular risk and CKD prevalence in the STEP study cohort.