Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older
Authors: William C. Cushman, Karen C. Johnson, William B. Applegate, Jeffrey A. Cutler
Journal: Annals of Internal Medicine (2017)

Letters15 August 2017Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or OlderWilliam C. Cushman, MD, Karen C. Johnson, MD, MPH, William B. Applegate, MD, MPH, and Jeffrey A. Cutler, MD, MPHWilliam C. Cushman, MDFrom Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee; Wake Forest University, Winston-Salem, North Carolina; and Consulting for Medical Research, Washington, DC.Search for more papers by this author, Karen C. Johnson, MD, MPHFrom Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee; Wake Forest University, Winston-Salem, North Carolina; and Consulting for Medical Research, Washington, DC.Search for more papers by this author, William B. Applegate, MD, MPHFrom Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee; Wake Forest University, Winston-Salem, North Carolina; and Consulting for Medical Research, Washington, DC.Search for more papers by this author, and Jeffrey A. Cutler, MD, MPHFrom Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee; Wake Forest University, Winston-Salem, North Carolina; and Consulting for Medical Research, Washington, DC.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0284 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We agree with Qaseem and colleagues (1) that there is strong evidence to support an SBP goal of less than 150 mm Hg in older adults with hypertension. However, we believe that the authors underestimate the strength of evidence for a goal of less than 120 mm Hg that is based on SPRINT, which showed a significant reduction in mortality of (−27%; P = 0.003) and cardiovascular events (−25%; P < 0.001) at this target (2). In Weiss and associates' accompanying meta-analysis (3), mortality and cardiac events were significantly reduced in the group of trials with a baseline blood ...References1. Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA; Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American Academy of Family Physicians. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166:430-7. [PMID: 28135725]. doi:10.7326/M16-1785 LinkGoogle Scholar2. Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103-16. [PMID: 26551272] doi:10.1056/NEJMoa1511939 CrossrefMedlineGoogle Scholar3. Weiss J, Freeman M, Low A, Fu R, Kerfoot A, Paynter R, et al. Benefits and harms of intensive blood pressure treatment in adults aged 60 years or older. A systematic review and meta-analysis. Ann Intern Med. 2017;166:419-29. [PMID: 28114673]. doi:10.7326/M16-1754 LinkGoogle Scholar4. Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA. 1970;213:1143-52. [PMID: 4914579] CrossrefMedlineGoogle Scholar5. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension.. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA. 1991;265:3255-64. [PMID: 2046107] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee; Wake Forest University, Winston-Salem, North Carolina; and Consulting for Medical Research, Washington, DC.Disclaimer: All authors are investigators in SPRINT. Dr. Cushman is an uncompensated consultant for Takeda and Novartis and has an institutional grant with Eli Lilly. The content is solely the responsibility of the authors and does not necessarily represent the official views of the SPRINT Research Group, National Institutes of Health, U.S. Department of Veterans Affairs, or U.S. government.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0284. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians Amir Qaseem , Timothy J. Wilt , Robert Rich , Linda L. Humphrey , Jennifer Frost , Mary Ann Forciea , and Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older Doreen M. Rabi , Stella S. Daskalopoulou , Alexander A. Leung , George Dresser , Raj Padwal , and Nadia Khan Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older Devan Kansagara , Timothy J. Wilt , Jennifer Frost , and Amir Qaseem Correction: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older Metrics Cited byCorrection: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older 15 August 2017Volume 167, Issue 4Page: 290-291KeywordsBlood pressureDisclosureElderlyHypertensionMortalityMyocardial infarctionPopulation statisticsTreatment guidelines ePublished: 15 August 2017 Issue Published: 15 August 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...