Outcomes of Intensive Blood Pressure Lowering in Older Hypertensive Patients.
BACKGROUND
The 2014 Eighth Joint National Committee panel recommended a therapeutic target of systolic blood pressure (BP) <150 mm Hg in patients ≥60 years of age, a departure from prior recommendation of <140 mm Hg.


OBJECTIVE
This study assessed the efficacy and safety of intensive BP-lowering strategies in older (age ≥65 years) hypertensive patients.


METHODS
The MEDLINE, Scopus, EMBASE, and Cochrane databases were searched for all relevant randomized controlled trials from 1965 through July 1, 2016. Cardiovascular (major adverse cardiovascular events [MACE], cardiovascular mortality, stroke, myocardial infarction, and heart failure), and safety (serious adverse events and renal failure) were evaluated. Random and fixed effects analysis were used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs).


RESULTS
We identified 4 high-quality trials involving 10,857 older hypertensive patients with a mean follow-up of 3.1 years. Intensive BP lowering was associated with a 29% reduction in MACE (RR: 0.71; 95% CI: 0.60 to 0.84), 33% in cardiovascular mortality (RR: 0.67; 95% CI: 0.45 to 0.98), and 37% in heart failure (RR: 0.63; 95% CI: 0.43 to 0.99) compared with standard BP lowering. Rates of myocardial infarction and stroke did not differ between the 2 groups. There was no significant difference in the incidence of serious adverse events (RR: 1.02; 95% CI: 0.94 to 1.09) or renal failure (RR: 1.81; 95% CI: 0.86 to 3.80) between the 2 groups. The fixed effects model yielded largely similar results, except for an increase in the risk of renal failure (RR: 2.03; 95% CI: 1.30 to 3.18) with intensive BP-lowering therapy.


CONCLUSIONS
In older hypertensive patients, intensive BP control (systolic BP <140 mm Hg) decreased MACE, including cardiovascular mortality and heart failure. Data on adverse events were limited, but suggested an increased risk of renal failure. When considering intensive BP control, clinicians should carefully weigh benefits against potential risks.
Department of Cardiovascular Diseases, Mount Sinai St. Luke's & Mount Sinai West Hospitals, New York, New York.
Chirag
C
Bavishi
Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.
Sripal
S
Bangalore
Department of Cardiology, Mount Sinai Medical Center, New York, New York; University of Bern, Switzerland and Jagiellonian University Krakow, Poland. Electronic address: messerli.f@gmail.com.
Franz H
FH
Messerli
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000517:prevention & control; D005260:Female; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D011897:Random Allocation; D051437:Renal Insufficiency / Q000209:etiology; D016896:Treatment Outcome
blood pressure; hypertension; older adults; prognosis