Lower BP targets show major benefits in elderly- reaffirms STEP trial from China

China: Lowering systolic blood pressure targets down to the 110 to less than 130 mm Hg range substantially reduced cardiovascular adverse events in the STEP randomized trial, affirming the SPRINT findings for an older, Chinese population with hypertension. The study is published in the New England Journal of Medicine.

There is no clarity on the appropriate target for systolic blood pressure to reduce the risk of cardiovascular disease in elderly patients with hypertension. To get some clarity on the topic, Weili Zhang, Chinese Academy of Medical Sciences, China, and colleagues performed a multicenter, randomized, controlled trial (STEP Trial) which included Chines patients 60 to 80 years of age with hypertension. They were assigned to a systolic blood-pressure target of 110 to less than 130 mm Hg (intensive treatment) or a target of 130 to less than 150 mm Hg (standard treatment).

The primary outcome was a composite of stroke, acute coronary syndrome (acute myocardial infarction and hospitalization for unstable angina), acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes.

9624 patients were screened for eligibility, out of which 8511 were enrolled in the trial; 4243 were randomly assigned to the intensive treatment group and 4268 to the standard treatment group. 

To sum up, in older hypertension patients, intensive treatment with a systolic blood-pressure target of 110 to less than 130 mm Hg resulted in a lower incidence of cardiovascular events than standard treatment with a target of 130 to less than 150 mm Hg.

Reference:

The study titled, "Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension," is published in the New England Journal of Medicine. 

DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2111437