Lowering Blood Pressure Among Older Patients Reduces Risk of Heart Failure

A new trial from the National Institutes of Health (NIH) found that a lower systolic blood pressure goal of 120 mm Hg reduces risk of cardiovascular events in geriatric populations.

About three-fourths of individuals older than 75 years have hypertension, which can lead to cardiovascular disease and, later on, disability, morbidity, and death. Guidelines have provided varying recommendations for ideal systolic blood pressure (SBP) treatment, and while the standard blood pressure goal is 140 millimeters of mercury (mm Hg), new findings from the NIH and its Systolic Blood Pressure Intervention Trial (SPRINT), published in JAMA, reveal that a lower SBP of 120 mm Hg can further reduce rates of cardiovascular events such as heart attack, heart failure, and stroke.

“If you look at elderly people who are hospitalized in the year that they become disabled and have to leave their home, about half the time those diagnoses or hospitalizations result from complications of hypertension, like heart failure, stroke and heart attack,” Jeff Williamson, MD, professor of gerontology and geriatric medicine at Wake Forest Baptist and lead author of the study, said in a statement.

The sample included 2636 adults aged 75 and older, excluding those with type 2 diabetes, symptomatic heart failure, prevalent stroke, and nursing home residents. Half of these individuals were randomly selected for intensive targeting of less than 120 mm Hg and the other half were targeted for less than 140 mm Hg. The team measured blood pressure, frailty status, and gait speed.

Overall, a lower blood pressure goal significantly lowers rates of fatal and nonfatal major cardiovascular events and death from any cause. Incident cardiovascular disease was reduced by 33% and total mortality was reduced by 32% for the 120 mm Hg group in comparison with the 140 mm Hg group. Primary composite outcome event was observed for 102 patients in the intensive treatment group and 148 for standard group. Results were similar for all-cause mortality with 73 deaths for the intensive group and 107 for the standard. There was no difference between complications related to low blood pressure between the intensive and the standard groups.

Benefits were true for both frail and non-frail participants. Event rates were higher as frailty increased, but absolute event rates were lower for intensive treatment group; the same was observed regarding gait speed.

Intensive blood pressure control for 3.14 years would be expected to prevent 1 primary outcome event for every 27 persons treated and 1 death from any cause for every 41 persons treated. On average, participants in the intensive treatment group required 1 more medication to reach the achieved lower blood pressure.

“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 high blood pressure complications can have on the independent function of older people,” Williamson said.