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Evidence summaries

Blood Pressure Targets for Hypertension in Older Adults

For hypertensive older adults, 65 years and older, a lower systolic blood pressure (BP) target of less than 140 mmHg, compared to a higher systolic BP target of less than 150 to 160 mmHg reduces strokes, and appears to reduce serious cardiovascular adverse events and cardiovascular mortality, but may not reduce all-cause mortality. Level of evidence: "A"

Summary

A Cochrane review [Abstract] 1 included 4 studies with a total of 16 732 subjects (mean age 70.3 years). One study compared a higher blood pressure (BP) target of < 150/90 mmHg to a lower target of < 140/90 mmHg, and 2 studies compared a purely systolic BP target of < 150 mmHg (1 study) and a systolic BP < 160 mmHg (1 study), to a systolic BP < 140 mmHg. The fourth study compared systolic BP target of 130 to 150 mmHg to a lower target of 110 to 130 mmHg.

There was no difference in all-cause mortality between higher and lower BP target over 2 to 4 years (table T1). The risk of stroke was increased with the higher BP target compared to the lower BP target, as was the risk of total serious cardiovascular adverse events, and the risk of cardiovascular mortality (RR 1.48, 95% CI 1.08 to 2.02; 4 studies, n=16 732). There was no difference in total serious adverse events (death, hospitalization and/or events requiring medical treatment; RR 0.93, 95% CI 0.69 to 1.24; 1 study, n=3 079) or withdrawals due to adverse effects (table T1).

Higher BP target compared with lower BP target in older adults with primary hypertension

Relative effect (95% CI)Risk with lower BP targetRisk with higher BP target (95% CI)Participants (studies)
All-cause mortalityRR 1.14(0.95 to 1.37)23 per 100027 per 1000(22 to 32)16 732(4)
StrokeRR 1.33(1.06 to 1.67)15 per 100021 per 1000(16 to 26)16 732(4)
Serious cardiovascular adverse events*RR 1.25(1.09 to 1.45)38 per 100048 per 1000(42 to 55)16 732(4)
Withdrawals due to adverse effectsRR 0.99(0.74 to 1.33)11 per 100011 per 1000(8 to 15)16 008(3)
* cerebrovascular disease, cardiac disease, vascular disease, and renal failure
Clinical comments

Note

Uncertainty still remains for the 'oldest old' (80 years of age and older), those who are frail, and those who have low diastolic BP at baseline.

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