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Intensive blood pressure control for patients aged over 60: A meta-analysis of the SPRINT, STEP, and ACCORD BP

Xiaoting Li1, Jiejun Zhang1, Zhenhua Xing2

  • 1Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Xiangya School of Medicine, Central South University, Changsha 410013, China.

Maturitas
|April 26, 2023
PubMed

Insights

Intensive blood pressure treatment in older adults lowered major adverse cardiovascular events and stroke risk but increased hypotension and syncope. Mortality and renal outcomes remained unchanged.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Clinical Trials

Background:

  • Older adults (over 60 years) are at increased risk for cardiovascular disease (CVD).
  • Determining optimal blood pressure (BP) targets in this demographic is crucial for effective CVD prevention.
  • Previous studies have yielded mixed results on the benefits and risks of intensive BP lowering in the elderly.

Approach:

  • A meta-analysis was conducted using individual-level data from the SPRINT, STEP, and ACCORD BP trials.
  • Included 18,806 participants over 60 years of age, randomized to standard or intensive BP treatment.
  • Hazard ratios (HRs) were calculated for major adverse cardiovascular events (MACEs), mortality, renal outcomes, and adverse events like hypotension and syncope.

Key Points:

  • Intensive BP treatment significantly reduced the incidence of MACEs (HR: 0.83) and stroke (HR: 0.70).
  • No significant reduction was observed in all-cause mortality (HR: 0.98) or cardiovascular mortality (HR: 0.77).
  • The risk of hypotension (HR: 1.46) and syncope (HR: 1.43) was significantly increased.

Conclusions:

  • Intensive BP lowering in adults over 60 reduces MACEs and stroke but elevates risks of hypotension and syncope.
  • No significant impact on mortality or renal outcomes was found.
  • These findings highlight a trade-off between benefits and risks for intensive BP management in older populations.
Abstract

Keywords:
AgedCardiovascular riskElderly patientsHypertensionIntensive blood pressure control

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