By Lucy Piper, medwireNews Reporter
medwireNews: Antihypertensive treatment of patients over the age of 80 years to a target systolic blood pressure (SBP) below 130 mmHg could significantly reduce their risk of death from cardiovascular disease (CVD) by 26%, suggests an analysis of NHANES data.
“Current guidelines, although supporting more intensive BP control, remain vague and lack robust evidence specific to this population, creating uncertainty for clinicians trying to balance risks and benefits”, observe Yuan Lu (Yale New Haven Hospital, Connecticut, USA) and co-investigators.
They write in the Journal of the American College of Cardiology that their findings support guidelines for “intensive BP management” in this patient population.
The researchers used NHANES data from 1988 to 2014 on 1593 individuals (59.6% women) aged 80 years and older who were receiving antihypertensive treatment.
They found that over a mean follow-up of 6.7 years, 1295 deaths occurred. The team notes that “CVD accounted for nearly one half (46.0%) of all deaths in this population, underscoring the importance of strict SBP management”.
The risk of death from CVD was significantly lower among participants who had SBP levels below 130.8 mmHg, compared with levels of 130–160 mmHg and above 160 mmHg, after taking into account demographic factors, smoking, antidiabetic and anti-lipid treatment, and the presence of stroke and myocardial infarction. By comparison, there was a significantly higher risk of CVD death among those with SBP levels above 145.0 mmHg.
The findings were consistent in sensitivity analyses that excluded participants who died within a year and 5 years of follow-up to rule out acute illness, with significant CVD death risk reductions of 29% and 41%, respectively. And by a significant 35% when the results were further adjusted for frailty, based on the Fried frailty phenotype.
Kaplan Meier analyses also demonstrated a significantly higher survival rate for individuals with SBP below 130 mmHg, compared with higher levels.
Lu et al point out that, while their findings support “rigorous SBP management” in patients aged over 80 years, “individualized treatment plans remain essential, particularly for frail individuals and those with comorbidities.”
They conclude that further research is needed “to clarify risks and benefits, especially at extreme SBPs”, noting that their study had limitations, including BP being measured at a single time point – restricting the ability to determine long-term variability – and complications associated with hypotension not being addressed.
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J Am Coll Cardiol 2025; 85: 1455–1458