Benefits of Treating Higher Versus Lower BP Targets in Older Adults Across all trials , treating high BP in older adults was beneficial .
This is probably related to the higher frequency of cardiovascular events seen in these patients .
Treatment Effects According to Diastolic BP Evidence was insufficient to determine the benefit of treating diastolic hypertension in the absence of systolic hypertension .
A subgroup analysis of SPRINT showed a nonstatistically significant increase in the rate of serious adverse events , hypotension , syncope , electrolyte abnormalities , or acute
Hypertension , an elevation of systemic arterial blood pressure ( BP ) , is a very common chronic disease in the United States .
The overall prevalence of hypertension among U.S. adults is 29.0 % , and it increases to 64.9 % in adults aged 60 years or older ( 1 ) .
Hypertension was associated with a total of $ 46 billion in health care services , medications , and missed days of work in the United States in 2011 ( 2 ) .
Appropriate management of hypertension reduces the risk for cardiovascular disease , renal disease , cerebrovascular disease , and death ( 36 ) .
However , determining the most appropriate BP targets , particularly for adults aged 60 years or older , has been controversial .
Debate about the goal for systolic BP ( SBP ) among adults treated for hypertension has intensified , especially in light of recent recommendations ( 7 ) .
In addition , when selecting BP targets for adults aged 60 years or older , clinicians need to consider comorbid conditions that could affect treatment choice .
Original Version ( PDF ) Guideline Focus and Target Population The purpose of this American College of Physicians ( ACP ) and American Academy of Family Physicians ( AAFP ) joint guideline is to present evidence -based recommendations on the benefits and harms of higher ( < 150 mm Hg ) versus lower ( 140 mm Hg ) SBP targets for the treatment of hypertension in adults aged 60 years or older .
These recommendations are based on a background evidence review ( 8) and systematic review sponsored by the U.S. Department of Veterans Affairs ( VA ) ( 9 ) .
Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial.
IMPORTANCE The appropriate treatment target for systolic blood pressure ( SBP ) in older patients with hypertension remains uncertain . OBJECTIVE To evaluate the effects of intensive ( < 120 mm Hg ) compared with st and ard ( < 140 mm Hg ) SBP targets in persons aged 75 years or older with hypertension but without diabetes . DESIGN , SETTING , AND PARTICIPANTS A multicenter , r and omized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial ( SPRINT ) . Recruitment began on October 20 , 2010 , and follow-up ended on August 20 , 2015 . INTERVENTIONS Participants were r and omized to an SBP target of less than 120 mm Hg ( intensive treatment group , n = 1317 ) or an SBP target of less than 140 mm Hg ( st and ard treatment group , n = 1319 ) . MAIN OUTCOMES AND MEASURES The primary cardiovascular disease outcome was a composite of nonfatal myocardial infa rct ion , acute coronary syndrome not result ing in a myocardial infa rct ion , nonfatal stroke , nonfatal acute decompensated heart failure , and death from cardiovascular causes . All-cause mortality was a secondary outcome . RESULTS Among 2636 participants ( mean age , 79.9 years ; 37.9 % women ) , 2510 ( 95.2 % ) provided complete follow-up data . At a median follow-up of 3.14 years , there was a significantly lower rate of the primary composite outcome ( 102 events in the intensive treatment group vs 148 events in the st and ard treatment group ; hazard ratio [ HR ] , 0.66 [ 95 % CI , 0.51 - 0.85 ] ) and all-cause mortality ( 73 deaths vs 107 deaths , respectively ; HR , 0.67 [ 95 % CI , 0.49 - 0.91 ] ) . The overall rate of serious adverse events was not different between treatment groups ( 48.4 % in the intensive treatment group vs 48.3 % in the st and ard treatment group ; HR , 0.99 [ 95 % CI , 0.89 - 1.11 ] ) . Absolute rates of hypotension were 2.4 % in the intensive treatment group vs 1.4 % in the st and ard treatment group ( HR , 1.71 [ 95 % CI , 0.97 - 3.09 ] ) , 3.0 % vs 2.4 % , respectively , for syncope ( HR , 1.23 [ 95 % CI , 0.76 - 2.00 ] ) , 4.0 % vs 2.7 % for electrolyte abnormalities ( HR , 1.51 [ 95 % CI , 0.99 - 2.33 ] ) , 5.5 % vs 4.0 % for acute kidney injury ( HR , 1.41 [ 95 % CI , 0.98 - 2.04 ] ) , and 4.9 % vs 5.5 % for injurious falls ( HR , 0.91 [ 95 % CI , 0.65 - 1.29 ] ) . CONCLUSIONS AND RELEVANCE Among ambulatory adults aged 75 years or older , treating to an SBP target of less than 120 mm Hg compared with an SBP target of less than 140 mm Hg result ed in significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01206062
Benefits of Treating Higher Versus Lower BP Targets in Older Adults Across all trials , treating high BP in older adults was beneficial .
This is probably related to the higher frequency of cardiovascular events seen in these patients .
Treatment Effects According to Diastolic BP Evidence was insufficient to determine the benefit of treating diastolic hypertension in the absence of systolic hypertension .
A subgroup analysis of SPRINT showed a nonstatistically significant increase in the rate of serious adverse events , hypotension , syncope , electrolyte abnormalities , or acute
Hypertension , an elevation of systemic arterial blood pressure ( BP ) , is a very common chronic disease in the United States .
The overall prevalence of hypertension among U.S. adults is 29.0 % , and it increases to 64.9 % in adults aged 60 years or older ( 1 ) .
Hypertension was associated with a total of $ 46 billion in health care services , medications , and missed days of work in the United States in 2011 ( 2 ) .
Appropriate management of hypertension reduces the risk for cardiovascular disease , renal disease , cerebrovascular disease , and death ( 36 ) .
However , determining the most appropriate BP targets , particularly for adults aged 60 years or older , has been controversial .
Debate about the goal for systolic BP ( SBP ) among adults treated for hypertension has intensified , especially in light of recent recommendations ( 7 ) .
In addition , when selecting BP targets for adults aged 60 years or older , clinicians need to consider comorbid conditions that could affect treatment choice .
Original Version ( PDF ) Guideline Focus and Target Population The purpose of this American College of Physicians ( ACP ) and American Academy of Family Physicians ( AAFP ) joint guideline is to present evidence -based recommendations on the benefits and harms of higher ( < 150 mm Hg ) versus lower ( 140 mm Hg ) SBP targets for the treatment of hypertension in adults aged 60 years or older .
These recommendations are based on a background evidence review ( 8) and systematic review sponsored by the U.S. Department of Veterans Affairs ( VA ) ( 9 ) .