January 2021
Should we Rethink Intensifying Blood Pressure Treatment for Lower Elderly Patients?
Firas Saidi, MD, CMD
There has been increasing interest in answering the question of the proper blood pressure control for older adults. The hypertension and the very elderly trial (HYVET) and the systolic blood pressure intervention trial (SPRINT) are the largest trials to examine the effectiveness of antihypertensive treatment in persons 80 and older. There was strong evidence that reduction of systolic blood pressure from 160 mmHg to 150 mmHg reduces the risk of CVD, heart failure and death from any cause in the HYVET study. This SPRINT trial took it down further to 120 mmHg and showed reduced risk of CVD and death which was sustained in a support group for participants age 80 and older.

The most recent study published in the Journal of the American Geriatric Society, Shephard et al. conducted a cross sectional study in 24 general practices in England. They have identified over 15,000 patients, of which 268 were eligible for the HYVET trial criteria, 5290 were eligible for the SPRINT trial criteria, and 3940 patients were eligible for the one medication reduction trial (OPTiMISE) criteria. The authors concluded that no trial evidence exists to inform treatment decisions in routine practices and caution should be exercised on applying results from such trials 1.

In an accompanying editorial2, Dr. Williamson argues that Dr. Shepherd and his colleagues’ findings that approximately 34% of adults over the age of 80 would be eligible for hypertension guidelines based on the SPRINT trial. This is not a small percentage. The American Heart Association/the American College of Cardiology BP control guidelines try to assist clinicians caring for older adults by recognizing that such patients have a high burden of comorbidity and life limiting factors, and clinical judgment as well as patient preference will have to inform the decision of whether or not intensifying BP lowering would be appropriate.

Any views or opinions presented in this article are solely those of the author and do not necessarily represent any policy or position of PAMED, PMDA, AMDA, its affiliates and members.
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