Study Examines "Ideal" Blood Pressure for Older Adults

January 8, 2020

A recent study found a lower blood pressure target in older adults could reduce risk of cardiovascular events and death, but could negatively impact kidney function.

With the age of the US population continuing to rise, the results of a recent study examining the ideal blood pressure for older patients could prove useful to cardiologists and clinicians as a whole.

The study, which analyzed data of participants in the SPRINT trial, found patients with a systolic blood pressure target below 120 mmHg experienced significant reductions in multiple adverse events, including cardiovascular events, mild cognitive impairment (MCI), and death.

To further evaluate the effect of intensive systolic blood pressure control in older adults with hypertension, investigators conducted a secondary analysis of a cohort from the SPRINT trial aged 80 or older. A total of 1167 participants were identified for inclusion.

Inclusion criteria for the study included not having diabetes, no diagnosis of dementia or use of medications for dementia therapy, no history of stroke, and participants could not reside in a nursing home. Of 1167 included in the current analysis were 581 randomized to standard treatment, defined as a goal of below 140 mmHg, and 586 were randomized to intensive treatment, which was a target of below 120 mmHg.

Outcomes of interest included the incidence of cardiovascular disease (CVD), mortality, changes in renal function, MCI, and serious adverse events. The median length of follow-up for each outcome was: 3.61 years for CVD, 3.75 years for all-cause mortality, 3.55 years for decline in eGFR, and 3.73 years for a composite of CVD and all-cause mortality. Median length of follow-up was 4.07 for probable dementia, 4.01 years, for MCI, and 4.06 years for a composite of both.

The mean age of the study population was 83.5±3.2 years and 3.3% were older than 90 at baseline. Due to the age of the population, they suffered from a variety of other comorbidities and confounding factors—specifically 89.8% having at least 3 comorbid conditions, 54.7% receiving at least 5 medications, and 27.2% having a history of cardiovascular disease.

Upon analysis, investigators found patients randomized to intensive treatment experienced a significant reduction in cardiovascular events, mortality, and MCI. Notably, 75 participants in the intensive treatment group experienced a primary composite CVD event versus 106 patients randomized to standard treatment.

Results of the analysis indicated a significant interaction with higher baseline scores on the Montreal Cognitive Assessment (MoCA) saw greater benefit from intensive treatment for a composite of CVD and mortality (HR: 0.40; 95% CI: 0.28&#8208;0.57) but with no appreciable benefit for patients with lower scores on the MoCA (HR: 1.33; 95% CI:0.87&#8208;2.03; P<0.001 for both).

Increases were observed in rates of acute kidney injury and declines of at least 30% in eGFR for patients in the intensive treatment group—no between-group differences were noted in the rate of falls resulting in injury. Investigators found no evidence of heterogeneity of treatment effects in regard to gait speed.

Based on the results, investigators suggest data the analyses indicate intensive systolic blood pressure control lowers the risk of multiple forms of adverse events, including cardiovascular and death, but could also increase risk of changes to kidney function. Additionally, some benefits of intensive treatment may not apply to older adults with lower cognitive function.

This study, titled “Intensive vs Standard Blood Pressure Control in Adults 80&thinsp;Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial,” was published online in the Journal of the American Geriatrics Society.