The optimal blood pressure target in old and very old patients with hypertension.

内容摘要

With the rise in older population globally, the optimal blood pressure (BP) target for antihypertensive therapy in those aged 60 and above remains to be evaluated in the real-world practice. This study evaluated the effectiveness and safety of standard versus lower BP targets in old (aged 60-79) and very old (aged ≥80) patients with hypertension in real-world clinical settings. We emulated a target trial using electronic medical records from the Hong Kong Hospital Authority, including patients aged 60 years or above with a diagnosis of hypertension, uncontrolled BP and records of antihypertensives adjustments from 2008 to 2013. Patients were first categorized into 3 age groups (60-69, 70-79, ≥ 80) and then assigned to BP targets of either 130-140/80-90 mmHg or below 130/80 mmHg. Outcomes included major cardiovascular disease (CVD), end-stage renal disease, all-cause mortality and major adverse events related to antihypertensive treatment. Of 132 430 eligible patients identified, 52 553, 28 661 and 7106 patients aged 60-69, 70-79 and ≥ 80 years had BP targets of 130-140/80-90 mmHg, respectively; 11 148, 5636 and 1203 of patients in the same age groups had targets below 130/80 mmHg. Lower BP target was associated with reduced overall CVD and all-cause mortality: aged 60-69 years (CVD HR: 0.91 [95% CI, 0.85-0.96]; all-cause mortality: 0.89 [0.81-0.98]), aged 70-79 years (CVD: 0.87 [0.82-0.93]; all-cause mortality: 0.84 [0.78-0.91]), and aged≥80 years (CVD: 0.77 [0.69-0.86]; all-cause mortality: 0.80 [0.72-0.89]). No significant increase in major adverse events was observed in any age group. Results were consistent across all subgroups. Lowering BP of below 130/80 mmHg in old and very old patients was associated with better cardiovascular and mortality outcomes without increased adverse events. These findings suggest that a lower BP target may be beneficial and safe for older patients with hypertension.