Intensive or Standard Blood Pressure Control for Patients Aged 80 and Older

January 7, 2020

Are the benefits of lowering systolic blood pressure to less than 130 mm Hg the same for those aged 80 years and older as they are for younger patients?

Intensive systolic blood pressure (SBP) control for adults aged 80 years and older can lower the risk of major cardiovascular (CV) events, mild cognitive impairment (MCI), and death, but could increase the risk of changes to kidney function, according to a new study.

The study, published in the Journal of American Geriatrics Society, investigated the effect of intensive SBP control in older adults with hypertension, considering cognitive and physical function.

Although risk of hypertension increases with age, intensive hypertension treatment for older adults may be complicated by multiple chronic conditions, such as frailty, polypharmacy, and cognitive impairment.

The study included 1167 patients with hypertension, but without diabetes, who were randomized to an SBP target below 120 mm Hg, defined as intensive treatment, versus a target below 140 mm Hg (standard treatment). Patients had a baseline SBP of around 142 mm Hg and most of the patients had at least 3 chronic health conditions. More than half were taking at least 5 medications and approximately 27% had a history of heart disease.

Overall, patients who received intensive treatment were more likely to experience significant reductions in CV events (hazard ratio [HR] = .66; 95% confidence interval [CI] – 49-.90), mortality (HR = .67; 95% CI =.48-.93), and MCI (HR=.70; 95% CI - .51-.96). However, there were also increased risks of small, but meaningful, declines in kidney function and hospitalizations for short-term kidney damage in the intensive treatment group. Importantly, there were no differences between groups in the rate of injury-causing falls, according to the study.

The researchers noted that, for adults aged 80 years and older, benefits of intensive SBP control may not extend to those with lower cognitive function. The study showed evidence that the beneficial effects on reducing heart disease and death were most prevalent among patents with higher cognitive performance in the trial than those with poor cognitive performance.

 

References:

1. Pajewski NM, Berlowitz DR, Bress AP, et al. Intensive vs standard blood pressure control in adults 80 years or older: a secondary analysis of the systolic blood pressure intervention trial. Journal of the American Geriatrics Society. 2019. https://doi.org/10.1111/jgs.16272