However , the 95 % confidence intervals of these outcomes suggest the lower BP target is probably not worse , and might offer a clinical ly important benefit .
AUTHORS ' CONCLUSIONS At the present time there is insufficient evidence to know whether a higher BP target ( less than150 to 160/95 to 105 mmHg ) or a lower BP target ( less than 140/90 mmHg ) is better for older adults with high BP .
BACKGROUND Eight out of 10 major antihypertensive trials in older adults attempted to achieve a target systolic blood pressure ( BP ) less than 160 mmHg .
Collectively these trials demonstrated benefit for treatment , as compared to no treatment , for an older adult with BP greater than 160 mmHg .
However an even lower BP target of less than 140 mmHg is commonly applied to all age groups .
At the present time it is not known whether a lower or higher BP target is associated with better cardiovascular outcomes in older adults .
OBJECTIVES To assess the effects of a higher ( less than 150 to 160/95 to 105 mmHg ) BP target compared to the lower BP target of less than 140/90 mmHg in hypertensive adults 65 years of age or older .
Impact of renal function on cardiovascular events in elderly hypertensive patients treated with efonidipine
This study evaluated the impact of renal function on cardiovascular outcomes in elderly hypertensive patients enrolled in the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive patients . The patients were r and omly assigned to either a  strict-treatment group ( target systolic blood pressure ( BP ) < 140 mm Hg , n=2212 ) or a mild-treatment group ( target systolic BP , 140 to < 160 mm Hg , n=2206 ) , each with efonidipine ( a T/L-type Ca channel blocker)-based regimens . Cardiovascular events ( stroke , cardiovascular disease and renal disease ) were evaluated during the 2-year follow-up period following the prospect i ve r and omized open-blinded end-point method . Estimated glomerular filtration rate ( eGFR ) was elevated throughout the trial period in both the strict-treatment ( 59.4–62 ml min−1 per 1.73 m2 ) and the mild-treatment group ( 58.8–61.4 ml min−1 per 1.73 m2 ) . This tendency was also observed in diabetic patients and patients aged ⩾75 years , with baseline eGFR<60 ml min−1 per 1.73 m2 . Baseline eGFR ( < 60 vs. ⩾60 ml min−1 per 1.73 m2 ) had no definite relationship with the incidence of cardiovascular events , nor did the level of BP control . Proteinuria at the time of entry into the study , however , was significantly correlated with cardiovascular event rates ( 7.1 % ) , an association that was more apparent in patients with eGFR<60 ml min−1 per 1.73 m2 ( 8.2 % ) . Furthermore , the event rate was more elevated in patients with greater declines in eGFR and was amplified when the baseline eGFR was < 60 ml min−1 per 1.73 m2 . In conclusion , the rates of decline of renal function and proteinuria constitute critical risk factors for cardiovascular events in elderly hypertensive patients , trends that are enhanced when baseline eGFR is diminished . Furthermore , the fact that efonidipine-based regimens ameliorate renal function in elderly hypertensive patients with chronic kidney disease may offer novel information on the mechanisms of cardiovascular protection
However , the 95 % confidence intervals of these outcomes suggest the lower BP target is probably not worse , and might offer a clinical ly important benefit .
AUTHORS ' CONCLUSIONS At the present time there is insufficient evidence to know whether a higher BP target ( less than150 to 160/95 to 105 mmHg ) or a lower BP target ( less than 140/90 mmHg ) is better for older adults with high BP .
BACKGROUND Eight out of 10 major antihypertensive trials in older adults attempted to achieve a target systolic blood pressure ( BP ) less than 160 mmHg .
Collectively these trials demonstrated benefit for treatment , as compared to no treatment , for an older adult with BP greater than 160 mmHg .
However an even lower BP target of less than 140 mmHg is commonly applied to all age groups .
At the present time it is not known whether a lower or higher BP target is associated with better cardiovascular outcomes in older adults .
OBJECTIVES To assess the effects of a higher ( less than 150 to 160/95 to 105 mmHg ) BP target compared to the lower BP target of less than 140/90 mmHg in hypertensive adults 65 years of age or older .