Hypertension is a risk factor for cardiovascular events, including coronary heart disease, stroke, and heart failure. The findings of studies in the past led the 2017 ACC/AHA Hypertension Guidelines to lower the blood pressure threshold from 140/90 mmHg to 130/80 mmHg. In addition, the guidelines recommend initiating antihypertensives in patients with a blood pressure between 130-139/80-89 mmHg and cardiovascular disease risk factors or those with a blood pressure greater than or equal to 140/90 mmHg.
This multicenter, prospective, randomized, control trial included 8,511 participants who were randomized to either intensive blood pressure management (target SBP 110 to <130 mmHg) or standard blood pressure management (target SBP 130-150 mmHg). Participants were included in the trial if they had a SBP between 140-190 mmHg in 3 screening visits or current use of a BP medication, between the age of 60-80 years old, and of Han Chinese descent. The primary outcomes of interest were stroke, acute coronary syndrome (myocardial infarct or unstable angina hospitalization), coronary revascularization, heart failure, acute decompensated heart failure, or cardiovascular mortality. Blood pressure was monitored weekly at home and every 1-3 weeks in a clinic. The study found that among a group of 60-80 year-old Han Chinese adults who did not have a prior hemorrhagic or ischemic stroke, intensive BP control (target SBP 110 to <130 mmHg) was associated with fewer cardiovascular disease events when compared to conventional BP control (target SBP 130-150 mmHg). During the median follow-up of 3.4 years, the primary-outcome events occurred in 147 of 4243 patients (3.5% [1.0% per year]) in the intensive-treatment group, as compared with 196 of 4268 patients (4.6% [1.4% per year]) in the standard-treatment group (hazard ratio, 0.74; 95% CI, 0.60 to 0.92; P=0.007). Although hypotension did occur frequently in the intensive BP control group, the incidence of dizziness, syncope, and fracture did not differ significantly between the two groups. This article shines light on the benefits of stricter BP goals in elderly patients who may be at risk of having a cardiovascular event.
Link to article: https://www-nejm-org.ezproxy.hsc.usf.edu/doi/10.1056/NEJMoa2111437?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed