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Blood pressure control in patients aged above and below 75 years
1Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea.
Insights
Blood pressure targets vary by age and risk factors. While older adults and those with fewer risks may benefit from relaxed systolic blood pressure (SBP) goals, individuals with multiple risk factors require stricter SBP control.
Area of Science:
- Cardiovascular Medicine
- Geriatrics
- Nephrology
- Neurology
Background:
- Optimal systolic blood pressure (SBP) targets for antihypertensive treatment remain debated, particularly concerning age and individual risk profiles.
- Existing guidelines lack specific age-based SBP targets, leading to uncertainty in clinical practice.
- The interplay between age, comorbidities, and SBP levels on clinical outcomes requires further elucidation.
Purpose of the Study:
- To determine age-specific systolic blood pressure (SBP) targets for antihypertensive treatment.
- To investigate the association between on-treatment SBP levels and cardio-kidney composite events, dementia, and all-cause mortality across different age groups and risk factor strata.
Main Methods:
- Analysis of a nationwide cohort of 296,470 hypertensive patients aged ≥75 years and a representative cohort of 259,028 hypertensives aged 45-74 years.
- Estimation of incidence rates for composite cardiovascular-kidney events, overt dementia, and all-cause deaths based on yearly-averaged on-treatment SBP levels.
- Multivariable adjustment for age and the presence of four additional risk factors: diabetes, dyslipidemia, albuminuria, and smoking.
Main Results:
- Positive associations between SBP and cardio-kidney events were observed, with attenuated risk in patients aged ≥85 years.
- SBP showed flat or inverted associations with dementia risk in the elderly, but a small positive association in younger adults (45-64 years).
- J-shaped associations were found for all-cause mortality, shifting towards higher SBP levels with increasing age. Stricter SBP control (145-154 mmHg vs. 125-134 mmHg) was associated with higher mortality rates in patients with multiple risk factors.
Conclusions:
- Systolic blood pressure targets can be relaxed in very elderly patients (≥85 years) and in older adults with fewer comorbidities.
- Conversely, stringent blood pressure control is recommended for hypertensive patients with multiple risk factors, irrespective of advanced age.
- These findings support personalized antihypertensive treatment strategies based on age and individual cardiovascular risk profiles.
Abstract:
It remains unclear what the blood pressure target is and at which point in life it is appropriate for antihypertensive treatment. This study aimed to determine age-specific systolic blood pressure (SBP) targets. In a nationwide cohort of 296,470 hypertensive patients aged ≥75 years and a representative cohort of 259,028 hypertensives aged 45-74 years, multivariable-adjusted incidence rates of cardio-kidney composite events, overt dementia, and all-cause deaths were estimated across yearly-averaged on-treatment SBP levels according to age and the presence of 4 additional risk factors (diabetes, dyslipidemia, albuminuria, and smoking). For cardio-kidney events, on-treatment SBP showed positive curvilinear associations with higher risks at ≥135 mm Hg in most while an attenuated association in age ≥85 years. For overt dementia, SBP showed flat or slightly inverted associations in elderly while a small positive association in age 45-64 years. For all-cause mortality, SBP showed J-shaped associations having right-shifting tendency with age. For risk categories with ≥2, 1, and no additional risk factors, the respective mortality rate differences between SBP 145-154 mm Hg and 125-134 mm Hg were 4.6 (95% confidence interval [CI], 2.0 to 7.3), 1.2 (95% CI, -0.3 to 2.8), and 0.1 (95% CI, -1.4 to 1.8) per 1000 person-years in age ≥75 years and 2.9 (95% CI, 1.7 to 4.3), 0.7 (95% CI, 0.1 to 1.4), and 0.9 (95% CI, 0.2 to 1.6) per 1000 person-years in age 45-74 years. In conclusion, the BP target can be relaxed in very old patients and in elderly patients with few risk factors. However, strict BP control may be needed in patients with multiple risk factors even in those with advanced age.
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