June 7, 2016

Blood pressure management for seniors

At a Glance

  • Seniors aiming for a target blood pressure level lower than commonly recommended had a reduced risk of cardiovascular disease and death.
  • The findings will help older adults with hypertension and their doctors make more informed decisions about blood pressure goals.
Nurse taking senior man’s blood pressure. Over time, consistently high blood pressure can weaken and damage blood vessels, which can lead to serious health problems.monkeybusinessimages/iStock/Thinkstock

High blood pressure, or hypertension, is a major public health problem. It affects 1 in 3 American adults—and 3 in 4 of those ages 75 and older. The condition usually causes no symptoms, but it’s an important risk factor for health problems including heart attack, heart failure, stroke, chronic kidney disease, and cognitive function decline.

Blood pressure is typically given as 2 numbers, such as 120/80 millimeters of mercury (mm Hg). The first number is systolic pressure, measured when the heart beats to pump blood. The second is diastolic pressure, measured when the heart is at rest between beats.

NIH’s National Heart, Lung, and Blood Institute (NHLBI), along with other NIH components, sponsored a study to test blood pressure targets for people with hypertension but without diabetes. The Systolic Blood Pressure Intervention Trial (SPRINT) compared a target systolic blood pressure of less than 120 mm Hg (intensive treatment) to a level of 140 mm Hg (standard treatment) in more than 9,300 participants, age 50 and older. SPRINT found that those treated at the lower target blood pressure level had a reduced risk of cardiovascular disease and death after a median follow-up of about 3 years.

The latest analysis from the study focused on the subgroup of more than 2,600 SPRINT participants who were 75 and older and randomly assigned to either the intensive or standard treatment goals (120 mm Hg or 140 mm Hg). The primary outcome was the same: a combination of several cardiovascular events, including heart attacks, heart failure, and strokes. Follow-up for this senior subgroup was a median of 3.14 years. The analysis of the senior subgroup was headed by Dr. Jeff Williamson at Wake Forest Baptist Medical Center. It appeared online on May 19, 2016, in the Journal of the American Medical Association.  

The mean systolic blood pressure achieved by seniors in the intensive treatment group was 123 mm Hg, compared to 135 mm Hg in the standard treatment group. Those in the intensive treatment group needed about 1 more medication to reach their lower goal.

Participants in the intensive treatment group had a significantly lower rate of cardiovascular events (affecting 102 participants, or 2.6% per year) than those in the standard treatment group (affecting 148 participants, or 3.8% per year). Those in the lower blood pressure group also had a reduced risk of death (73 deaths, or 1.8% per year vs. 107 deaths, or 2.6% per year). These benefits occurred in both frail and non-frail participants (assessed using a frailty index of 37 diverse items).

The overall rate of serious adverse events in seniors didn’t differ between the treatment groups. The intensive treatment group had slightly higher levels of certain events, such as low blood pressure, fainting, and acute kidney injury. The benefits likely outweigh these risks, but longer term follow-up will be needed to further assess these issues.

“These findings have substantial implications for the future of high blood pressure therapy in older adults because of its high prevalence in this age group, and because of the devastating consequences that high blood pressure complications can have on the independent function of older people,” Williamson says.

People with hypertension should talk to a doctor about whether a lower goal is best for their situation.

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Reference: Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, Fine LJ, Haley WE, Hawfield AT, Ix JH, Kitzman DW, Kostis JB, Krousel-Wood MA, Launer LJ, Oparil S, Rodriguez CJ, Roumie CL, Shorr RI, Sink KM, Wadley VG, Whelton PK, Whittle J, Woolard NF, Wright JT Jr, Pajewski NM; SPRINT Research Group. JAMA. 2016 May 19. doi: 10.1001/jama.2016.7050. [Epub ahead of print]. PMID: 27195814.

Funding: NIH’s National Heart, Lung, and Blood Institute (NHLBI), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Aging (NIA), National Institute of Neurological Disorders and Stroke (NINDS), National Center for Advancing Translational Sciences (NCATS), and National Institute of General Medical Sciences (NIGMS); U.S. Department of Veterans Affairs; and Takeda Pharmaceuticals International Inc.