Intensive BP treatment benefits elderly hypertensives with life expectancy more than 3 years: JAMA

Recent guidelines recommend a systolic blood pressure (BP) goal of less than 150 mm Hg or even 130 mm Hg for 60 years or older adults. However, harms from intensive BP treatments occur immediately (eg, syncope, fall), and benefits for cardiovascular event reduction emerge over time. Therefore, harms with low chance of benefit need to be clearer, particularly for those with limited life expectancy.

A study was conducted to estimate the time needed to potentially derive clinical benefit from intensive BP treatment in patients 60 years and older.

This secondary analysis included individual patient data from published randomized clinical trials with 27 414 patients 60 years or older with hypertension. Patient-level survival data were reconstructed when the original data were not available. Published trials were identified by searching PubMed until October 15, 2021.Intensive BP lowering vs standard BP lowering with the treat-to-target design.Major adverse cardiovascular event (MACE) defined by each trial, which was broadly similar to all trials, including myocardial infarction, stroke, and cardiovascular mortality.

The results of the study are:

• The analysis included six trials (original data from 2 trials and reconstructed data from 4 trials) with 27 414 participants (mean age, 70 years; 56.3% were women). Intensive BP treatment with a systolic BP target below 140 mm Hg was significantly associated with a 21% reduction in MACE
• On average, 9.1 months were needed to prevent 1 MACE per 500 patients with the intensive BP treatment
• Likewise, 19.1 and 34.4 months were estimated to avoid 1 MACE per 200 and 100 patients.

Thus, in this analysis, findings suggest that for patients 60 years and older with hypertension, intensive BP treatment may be appropriate for some adults with a life expectancy of greater than 3 years but may not be suitable for those with less than 1 year.

Reference:

Time to Clinical Benefit of Intensive Blood Pressure Lowering in Patients 60 Years and Older With Hypertension: A Secondary Analysis of Randomized Clinical Trials by Tao Chen, et al. published in the JAMA Internal Medicine.

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