SBP lowering prevents death, cardiac events in older hypertensive patients

In older patients with hypertension, achieving an average on-treatment systolic blood pressure (SBP) of <130 mm Hg appears to result in improved outcomes without any safety concerns, suggest the results of a recent study.

In this multicentre, retrospective study, the authors extracted and examined data from the Korea University Medical Center database built of electronic health records from 2017 to 2022. Patients treated with at least two antihypertensive medications were followed for 3 years. They were then categorized by average on-treatment SBP in 10-mm Hg increments from <110 to 160 mm Hg or more.

A composite of all-cause death, myocardial infarction, stroke, and hospitalization due to heart failure served as the primary outcome.

Overall, 6,427 patients aged ≥75 years (mean age 80 years) were assessed in this study. The lowest incidence of the primary outcome was observed in individuals with an SBP of 120‒129 mm Hg (14.0 percent; p<0.001), with an adjusted hazard ratio showing a J-shaped relationship with on-treatment SBP.

Patients who achieved an SBP of 120‒129 mm Hg exhibited no serious safety signals, such as electrolyte imbalance, acute kidney injury, new-onset atrial fibrillation, and new-onset dementia or Alzheimer’s disease, relative to those with SBP of 130‒139 mm Hg.

“These findings support the target SBP of 130 mm Hg in older patients, if tolerated,” the authors said.