Target Blood Pressure for Treatment of Isolated Systolic Hypertension in the Elderly

TLDR

The study aimed to determine whether strict blood pressure control (<140 mm Hg) reduces cardiovascular events compared to moderate control (≥140 to <150 mm Hg) in elderly patients with isolated systolic hypertension. 3260 patients aged 70–84 with isolated systolic hypertension were randomized to strict or moderate BP treatment and followed for a median of 3.07 years to assess a composite cardiovascular endpoint. After 3 years, strict control achieved lower BP (136.6/74.8 vs 142.0/76.5 mm Hg) and a non‑significant 11 % relative reduction in the composite cardiovascular event rate (10.6 vs 12.0 per 1000 patient‑years, HR 0.89, 95 % CI 0.60–1.34, P = 0.38), indicating that <140 mm Hg targets are achievable but the study lacked power to confirm superiority.

Abstract

In this prospective, randomized, open-label, blinded end point study, we aimed to establish whether strict blood pressure control (&lt;140 mm Hg) is superior to moderate blood pressure control (≥140 mm Hg to &lt;150 mm Hg) in reducing cardiovascular mortality and morbidity in elderly patients with isolated systolic hypertension. We divided 3260 patients aged 70 to 84 years with isolated systolic hypertension (sitting blood pressure 160 to 199 mm Hg) into 2 groups, according to strict or moderate blood pressure treatment. A composite of cardiovascular events was evaluated for ≥2 years. The strict control (1545 patients) and moderate control (1534 patients) groups were well matched (mean age: 76.1 years; mean blood pressure: 169.5/81.5 mm Hg). Median follow-up was 3.07 years. At 3 years, blood pressure reached 136.6/74.8 mm Hg and 142.0/76.5 mm Hg, respectively. The blood pressure difference between the 2 groups was 5.4/1.7 mm Hg. The overall rate of the primary composite end point was 10.6 per 1000 patient-years in the strict control group and 12.0 per 1000 patient-years in the moderate control group (hazard ratio: 0.89; [95% CI: 0.60 to 1.34]; P =0.38). In summary, blood pressure targets of &lt;140 mm Hg are safely achievable in relatively healthy patients ≥70 years of age with isolated systolic hypertension, although our trial was underpowered to definitively determine whether strict control was superior to less stringent blood pressure targets.