title: Benefits and Harms of Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Recent guidelines recommend a systolic blood pressure (SBP) goal of less than 150 mm Hg for adults aged 60 years or older, but the balance of benefits and harms is unclear in light of newer evidence.
  
  
  OBJECTIVE
  To systematically review the effects of more versus less intensive BP control in older adults.
  
  
  METHODS
  Multiple databases through January 2015 and MEDLINE to September 2016.
  
  
  METHODS
  21 randomized, controlled trials comparing BP targets or treatment intensity, and 3 observational studies that assessed harms.
  
  
  METHODS
  Two investigators extracted data, assessed study quality, and graded the evidence using published criteria.
  
  
  RESULTS
  Nine trials provided high-strength evidence that BP control to less than 150/90 mm Hg reduces mortality (relative risk [RR], 0.90 [95% CI, 0.83 to 0.98]), cardiac events (RR, 0.77 [CI, 0.68 to 0.89]), and stroke (RR, 0.74 [CI, 0.65 to 0.84]). Six trials yielded low- to moderate-strength evidence that lower targets (≤140/85 mm Hg) are associated with marginally significant decreases in cardiac events (RR, 0.82 [CI, 0.64 to 1.00]) and stroke (RR, 0.79 [CI, 0.59 to 0.99]) and nonsignificantly fewer deaths (RR, 0.86 [CI, 0.69 to 1.06]). Low- to moderate-strength evidence showed that lower BP targets do not increase falls or cognitive impairment.
  
  
  CONCLUSIONS
  Data relevant to frail elderly adults and the effect of multimorbidity are limited.
  
  
  CONCLUSIONS
  Treatment to at least current guideline standards for BP (<150/90 mm Hg) substantially improves health outcomes in older adults. There is less consistent evidence, largely from 1 trial targeting SBP less than 120 mm Hg, that lower BP targets are beneficial for high-risk patients. Lower BP targets did not increase falls or cognitive decline but are associated with hypotension, syncope, and greater medication burden.
  
  
  BACKGROUND
  U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. (PROSPERO 2015: CRD42015017677).
authors.affiliation: From Veterans Affairs Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
authors.forename: Jessica
authors.initials: J
authors.lastname: Weiss
authors.affiliation: From Veterans Affairs Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
authors.forename: Michele
authors.initials: M
authors.lastname: Freeman
authors.affiliation: From Veterans Affairs Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
authors.forename: Allison
authors.initials: A
authors.lastname: Low
authors.affiliation: From Veterans Affairs Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Fu
authors.affiliation: From Veterans Affairs Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
authors.forename: Amy
authors.initials: A
authors.lastname: Kerfoot
authors.affiliation: From Veterans Affairs Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
authors.forename: Robin
authors.initials: R
authors.lastname: Paynter
authors.affiliation: From Veterans Affairs Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
authors.forename: Makalapua
authors.initials: M
authors.lastname: Motu'apuaka
authors.affiliation: From Veterans Affairs Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
authors.forename: Karli
authors.initials: K
authors.lastname: Kondo
authors.affiliation: From Veterans Affairs Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
authors.forename: Devan
authors.initials: D
authors.lastname: Kansagara
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003072:Cognition Disorders / Q000139:chemically induced; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007022:Hypotension / Q000139:chemically induced; D007674:Kidney Diseases / Q000139:chemically induced; D008875:Middle Aged; D011788:Quality of Life; D018570:Risk Assessment; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control; D013575:Syncope / Q000139:chemically induced
chemical_list: D000959:Antihypertensive Agents