Blood pressure targets for hypertension in older adults

There is insufficient evidence to determine whether a higher systolic blood pressure (BP) target of less than 150 to 160 mmHg, as compared to a lower systolic BP target of less than 140 mmHg, conveys meaningful differences in benefit or harm to older adults with hypertension.

The quality of evidence is downgraded by study limitations (unclear allocation concealment), by inconsistency (unexplained variability in results), and by imprecise results (few outcome events and wide confidence intervals).

Summary

A Cochrane review included 3 studies with a total of 8 221 subjects (mean age 74.8 years). Higher blood pressure (BP) targets (less than 150/90 mmHg in 2 studies and less than 160/90 mmHg in 1 study) were compared to a lower target of less than 140/90 mmHg. Study duration varied between 2 to 4 years. Meta-analyses comparing higher vs. lower BP target failed to produce a difference in any of the primary outcomes, including all-cause mortality (RR 1.24 95% CI 0.99 to 1.54, statistical heterogeneity I²=79%; 3 studies, n=8 221), stroke (RR 1.25 95% CI 0.94 to 1.67; 3 studies, n=8 221) and total cardiovascular serious adverse events (cerebrovascular disease, cardiac disease, vascular disease and renal failure; RR 1.19 95% CI 0.98 to 1.45, statistical heterogeneity, I²=59%; 3 studies, n=8 221). Pooling data for cardiovasculafr mortality (secondary outcome) produced a statistically significant difference showing the higher target to be inferior (RR 1.52, 95% CI 1.06 to 2.19, statistical heterogeneity I²=52%; 3 studies, n= 8221). Data on adverse effects were not available from all trials and not different, including total serious adverse events, total minor adverse events, and withdrawals due to adverse effects.

Clinical comments

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Ədəbiyyat

1. Garrison SR, Kolber MR, Korownyk CS et al. Blood pressure targets for hypertension in older adults. Cochrane Database Syst Rev 2017;(8):CD011575.