TY - JOUR

T1 - Intensive blood pressure lowering in different age categories

T2 - insights from the Systolic Blood Pressure Intervention Trial

AU - Byrne, Christina

AU - Pareek, Manan

AU - Vaduganathan, Muthiah

AU - Biering-Sorensen, Tor

AU - Qamar, Arman

AU - Pandey, Ambarish

AU - Olesen, Thomas Bastholm

AU - Olsen, Michael Hecht

AU - Bhatt, Deepak L.

PY - 2020

Y1 - 2020

N2 - Aims The 2018 ESC/ESH guidelines for hypertension recommend differential management of patients who are = 80 years of age. However, it is unclear whether intensive blood pressure towering is well-tolerated and modifies risk uniformly across the age spectrum.Methods and results SPRINT randomized 9361 high-risk adults without diabetes and age >= 50 years with systolic blood pressure 130-180 mmHg to either intensive or standard antihypertensive treatment. The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. The primary safety endpoint was composite serious adverse events. We assessed whether age modified the efficacy and safety of intensive vs. standard blood pressure lowering using Cox proportional-hazards regression and restricted cubic splines. In all, 3805 (41%), 4390 (47%), and 1166 (12%) were = 80 years. Mean age was similar between the two study groups (intensive group 67.9 +/- 9.4years vs. standard group 67.9 +/- 9.5 years; P=0.94). Median follow-up was 3.3 years. In multivariable models, age was linearly associated with the risk of stroke (P<0.001) and non-linearly associated with the risk of primary efficacy events, death from cardiovascular causes, death from any cause, heart failure, and serious adverse events (P 0.05).Conclusion In SPRINT, the benefits and risks of intensive blood pressure lowering did not differ according to the age categories proposed by the ESC/ESH guidelines for hypertension.

AB - Aims The 2018 ESC/ESH guidelines for hypertension recommend differential management of patients who are = 80 years of age. However, it is unclear whether intensive blood pressure towering is well-tolerated and modifies risk uniformly across the age spectrum.Methods and results SPRINT randomized 9361 high-risk adults without diabetes and age >= 50 years with systolic blood pressure 130-180 mmHg to either intensive or standard antihypertensive treatment. The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. The primary safety endpoint was composite serious adverse events. We assessed whether age modified the efficacy and safety of intensive vs. standard blood pressure lowering using Cox proportional-hazards regression and restricted cubic splines. In all, 3805 (41%), 4390 (47%), and 1166 (12%) were = 80 years. Mean age was similar between the two study groups (intensive group 67.9 +/- 9.4years vs. standard group 67.9 +/- 9.5 years; P=0.94). Median follow-up was 3.3 years. In multivariable models, age was linearly associated with the risk of stroke (P<0.001) and non-linearly associated with the risk of primary efficacy events, death from cardiovascular causes, death from any cause, heart failure, and serious adverse events (P 0.05).Conclusion In SPRINT, the benefits and risks of intensive blood pressure lowering did not differ according to the age categories proposed by the ESC/ESH guidelines for hypertension.

KW - Age

KW - Blood pressure

KW - Hypertension

KW - Safety

KW - CARDIOVASCULAR EVENTS

KW - HYPERTENSION

KW - FRAILTY

KW - DISEASE

KW - PEOPLE

KW - RISK

U2 - 10.1093/ehjcvp/pvz050

DO - 10.1093/ehjcvp/pvz050

M3 - Journal article

C2 - 31529024

VL - 6

SP - 356

EP - 363

JO - European Heart Journal - Cardiovascular Pharmacotherapy

JF - European Heart Journal - Cardiovascular Pharmacotherapy

SN - 2055-6837

IS - 6

ER -