At age 60 to 80, systolic pressure of 110 to <130 produces clear health benefits

Reuters Health - 01/09/2021  - Intensive treatment to bring systolic blood pressure down to the 110 to 129 mm Hg range in people age 60 to 80 reduces the combined risk of stroke, acute coronary syndrome, and other health consequences by 26%, according to a study of more than 8,000 Chinese who were followed for a year.

The improvements were compared to older people with hypertension whose target treatment range was 130 to less than 150 mm Hg.

The findings were presented virtually during the European Society of Cardiology Congress 2021 and published in the New England Journal of Medicine.

The randomized trial, known as STEP, was an attempt to bring some clarity to the best pressure at a time when different professional groups recommend different targets.

The American College of Physicians and American Academy of Family Physicians recommend a pressure below 150 mm Hg for that age group. European guidelines advise 130 to 139. The American College of Cardiology and American Heart Association say the reading should be below 130.

The STEP researchers arranged to have the readings taken at home using a monitor and smartphone app to avoid the drawbacks of in-office measurements.

The original plan was to follow the volunteers, whose starting systolic pressures were 140 to 190 mm Hg, for four years. The trial was stopped early with a median follow-up of 3.3 years because the findings were so clearcut.

People with a history of stroke were excluded. The study was not blinded.

Ultimately, 77.2% of the patients in the intensive-treatment group reached their systolic target by taking an average of 1.9 medications. In the standard-treatment group, the mean number of blood pressure medicines was 1.5, and 78.7% of those people reached their target.

The primary outcome was a combination of stroke, heart attack, hospitalization for unstable angina, coronary revascularization, atrial fibrillation, acute decompensated heart failure or death from a cardiovascular cause.

The rates were 3.5% with intensive treatment and 4.6% with standard treatment (P=0.007). The rate of death from any cause was 0.5% per year in both groups.

When the researcher team, led by Dr. Weili Zhang of the National Center for Cardiovascular Diseases, in Beijing, looked at the odds of individual indicators, they found that intensive treatment produced a significantly lower risk of stroke, acute coronary syndrome and acute decompensated heart failure, but not the odds of death from any cause, death from cardiovascular causes, atrial fibrillation, or coronary revascularization.

"The incidences of dizziness, syncope, and fracture and the results for renal outcomes did not differ significantly between the two trial groups," the team reports, "nor did the incidences of angioedema, headache, cough, and hives. However, the incidence of hypotension was significantly higher in the intensive-treatment group than in the standard-treatment group (3.4% vs. 2.6%, P = 0.03)."

One of the strengths of the trial was the use of home blood pressure monitoring.

"Home blood pressure monitoring more accurately reflects the long-term fluctuations in blood pressure than office blood-pressure monitoring and facilitates hypertension management for older patients," the researchers said.

The study did not have commercial funding.

SOURCE: https://bit.ly/3D The New England Journal of Medicine, online August 30, 2021.

By Reuters Staff



Posted on 1 September, 20219 September, 2021