A new study suggests that adults with hypertension aged 75 and older might benefit from intensive blood pressure (BP) treatment that lowers BP below the current medical guidelines. These benefits include elderly people who are frail and possess poor overall health.
"The reason I'm excited about this is the implications for public health," said Mark Supiano of the University of Utah and co-author of the study. "There are 5.8 million people age 75 and older who could potentially benefit. It's a large number and we need to pay attention to it."
Elderly adults who qualify are those that meet the same criteria as Systolic Blood Pressure Intervention Trial (SPRINT) participants, which includes high blood pressure, no diabetes and no history of stroke.
SPRINT was a large, randomized clinical trial that used medication to reduce systolic blood pressure to 120 mmHg, which is lower than the currently recommended 140 to 150 mmHg. The results of the trial suggested that this reduction reduced the risk of heart disease and death in the participants.
The new study examines whether older adults who are more susceptible to the side effects of such intensive treatment can benefit from it. The results reveal that those aged 75 and older experience major benefits from this treatment, even if they are fragile and possess poor health.
In particular, intensive blood pressure lowering caused 33 percent fewer cases of cardiovascular events and 32 percent fewer deaths. Furthermore, although frail patients typically have higher rates of heart disease and death, intensive blood pressure treatment lowered them from 5.8 percent to 3.9 percent and from 4.28 percent to 2.95 percent, respectively.
The team also found that this intensive blood pressure lowering treatment did not significantly increase the risk for serious side effects in the frail group, suggesting that it is relatively safe.
"This subgroup analysis of the SPRINT trial is significant because many physicians and patients have been concerned about blood pressure being too low in the elderly," said Alfred Cheung of the University of Utah and a member of the SPRINT Research Group. "These results are reassuring and could very well change current medical practice by lowering the blood pressure goal even in people over 75 years old."
Further research will need to examine the effects of intensive blood pressure treatment on various aspects of cognitive functioning such as thinking and memory.
The findings were published in the May 19 issue of The Journal of the American Medical Association.
