Outcomes of Intensive Blood Pressure Lowering in Older Hypertensive Patients

被引:120
|
作者
Bavishi, Chirag [1 ,2 ,3 ]
Bangalore, Sripal [4 ]
Messerli, Franz H. [5 ,6 ,7 ]
机构
[1] Mt Sinai Hosp, Dept Cardiovasc Med, New York, NY 10029 USA
[2] St Lukes Hosp, Dept Cardiovasc Med, New York, NY USA
[3] Mt Sinai West Hosp, Dept Cardiovasc Med, New York, NY USA
[4] NYU, Sch Med, Leon H Charney Div Cardiol, New York, NY USA
[5] Mt Sinai Med Ctr, Dept Cardiol, New York, NY 10029 USA
[6] Univ Bern, Bern, Switzerland
[7] Jagiellonian Univ, Krakow, Poland
关键词
blood pressure; hypertension; older adults; prognosis; ANTIHYPERTENSIVE TREATMENT; TARGETS; TRIAL;
D O I
10.1016/j.jacc.2016.10.077
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND The 2014 Eighth Joint National Committee panel recommended a therapeutic target of systolic blood pressure (BP) <150 mm Hg in patients 60 years of age, a departure from prior recommendation of <140 mm Hg. OBJECTIVES This study assessed the efficacy and safety of intensive BP-lowering strategies in older (age >= 65 years) hypertensive patients. METHODS The MEDLINE, Scopus, EMBASE, and Cochrane databases were searched for all relevant randomized controlled trials from 1965 through July 1, 2016. Cardiovascular (major adverse cardiovascular events [MACE], cardiovascular mortality, stroke, myocardial infarction, and heart failure), and safety (serious adverse events and renal failure) were evaluated. Random and fixed effects analysis were used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). RESULTS We identified 4 high-quality trials involving 10,857 older hypertensive patients with a mean follow-up of 3.1 years. Intensive BP lowering was associated with a 29% reduction in MACE (RR: 0.71; 95% CI: 0.60 to 0.84), 33% in cardiovascular mortality (RR: 0.67; 95% CI: 0.45 to 0.98), and 37% in heart failure (RR: 0.63; 95% CI: 0.43 to 0.99) compared with standard BP lowering. Rates of myocardial infarction and stroke did not differ between the 2 groups. There was no significant difference in the incidence of serious adverse events (RR: 1.02; 95% CI: 0.94 to 1.09) or renal failure (RR: 1.81; 95% CI: 0.86 to 3.80) between the 2 groups. The fixed effects model yielded largely similar results, except for an increase in the risk of renal failure (RR: 2.03; 95% CI: 1.30 to 3.18) with intensive BP-lowering therapy. CONCLUSIONS In older hypertensive patients, intensive BP control (systolic BP <140 mm Hg) decreased MACE, including cardiovascular mortality and heart failure. Data on adverse events were limited, but suggested an increased risk of renal failure. When considering intensive BP control, clinicians should carefully weigh benefits against potential risks. (C) 2017 by the American College of Cardiology Foundation.
引用
收藏
页码:486 / 493
页数:8
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