Recommendations for blood pressure (BP) treatment and targets vary widely by age and by guidelines, in particular for older patients, in whom the appropriate BP-lowering strategy to reduce the risk of cardiovascular events is unclear. Two new studies, presented at the ESC Congress 2021, address these issues and show that pharmacological BP reduction is effective in older patients with hypertension and that a more intensive treatment with a lower BP threshold reduces the incidence of cardiovascular events.
“Although previous studies have investigated the effect of BP treatment by age, they had been limited in size and depth, in particular in the group of older patients aged over 75 years,” explains Kazem Rahimi, of The Blood Pressure Lowering Treatment Trialists’ Collaboration. “One of the most remarkable features of our collaborative study is its scale,” he adds. In their meta-analysis, Rahimi and colleagues included data from 51 large-scale, randomized trials of pharmacological BP lowering, with a total of 358,707 participants, including more than 20,000 participants aged over 80 years. With the individual participant-level data, the investigators were able to group participants simultaneously by five categories of age and seven categories of BP. “When investigated in this way, we saw that the common assumption that BP lowering should start at higher thresholds in older individuals is not justified,” says Rahimi. Indeed, the results showed that pharmacological BP lowering is effective into old age for reducing major cardiovascular events, with no evidence that relative risk reductions differ by systolic or diastolic BP levels at baseline, down to below 120/70 mmHg.
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