Older adults who were 75 and older, frail or taking multiple medications (polypharmacy) had greater net benefits from efforts to lower systolic blood pressure compared to those aged 65 to 74. However, they experienced more harms related to the treatment compared to the younger cohort, a new study shows.
Researchers examined the benefits and harms of intensively lowering blood pressure in community-dwelling older adults based on different characteristics including age, frailty status and medication use. The team evaluated the benefits and harms based on intensive blood pressure lowering (getting systolic blood pressure under 120 mm Hg) compared to standard blood pressure lowering (keeping levels under 140 mm Hg).
The previously conducted Systolic Blood Pressure Intervention Trial (SPRINT) advocated for efforts to reduce blood pressure in adults with hypertension in order to reduce their risk for cardiovascular disease and early death. The current study used data from SPRINT.
The study published Tuesday in the Journal of the American Geriatrics Society found that almost all of the adults in the trial had a positive overall benefit when targets were under 120 mmH. The degree of benefit, however, varied based on predicted risks and simulated outcomes.
All of the 5,143 participants fell into two groups: They were aged 50 and older and had systolic blood pressure between 130 mm Hg and 180 mm Hg, or they had high cardiovascular disease risk, were 75 and up or had a 10-year cardiovascular risk over 15%, according to the Framingham risk score. Among participants at the start of the study, 23% had a history of cardiovascular disease, 33% were defined as frail and 63% took multiple prescription medications. During the study, 5% of participants died. More people in the group over 75 experienced things like stroke, heart failure, acute kidney injury, and falls.
“Consideration of advanced age, frailty, and polypharmacy alone should not deter clinicians from recommending intensive blood pressure lowering,” the authors wrote.