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 .
INtensive versus standard ambulatory blood pressure lowering to prevent functional DeclINe in the ElderlY (INFINITY).
Reductions in mobility and cognitive function linked to accrual of brain microvascular disease related white matter hyperintensities ( WMHs ) on magnetic resonance imaging can occur in older hypertensive patients in as little as 2 years . We have design ed a trial evaluating 2 levels of ambulatory blood pressure ( ABP ) control in individuals with normal or mildly impaired mobility and cognition who have detectable cerebrovascular disease ( > 0.5 % WMH fraction of intracranial volume ) on functional outcomes . The study is a prospect i ve r and omized , open-label trial with blinded end points , in patients ages ≥75 years with elevated 24-hour systolic blood pressure ( BP ) ( 145 mm Hg in the untreated state ) who do not have unstable cardiovascular disease , heart failure , or stroke . The primary and key secondary outcomes in the trial are change from baseline in mobility and cognitive function and damage to brain white matter as demonstrated by accrual of WMH volume and changes in diffusion tensor imaging . Approximately 300 patients will be enrolled , and 200 r and omized to 1 of 2 levels of ABP control ( intensive to achieve a goal 24-hour systolic BP of ≤130 mm Hg or st and ard to achieve a goal 24-hour systolic BP of ≤145 mm Hg ) for a total of 36 months using similar antihypertensive regimens . The analytical approach provides 85 % power to show a clinical ly meaningful effect in differences in mobility accompanied by quantitative differences in WMH between treatment groups . The INFINITY trial is the first to guide antihypertensive therapy using ABP monitoring rather than clinic BP to reduce cerebrovascular disease
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 .