Winston-Salem, NC—Intensifying hypertension treatment in older adults has been considered a double-edged sword: While a drop in the risk of heart disease might be desirable, an expected increase in dangerous falls is not.
A new study published recently in the Journal of the American Medical Association might change that calculation, however.
Wake Forest Baptist Medical Center–led research found that, in ambulatory adults aged 75 years or older, adjusting the amount or type of blood pressure medication to achieve a target systolic pressure of 120 millimeters of mercury (mm Hg) reduced rates of cardiovascular events such as heart attack, heart failure, and stroke by almost a third and the risk of death by almost a quarter, as compared to a target systolic pressure of 140 mm Hg.
At the same time, the National Institutes of Health-sponsored Systolic Blood Pressure Intervention Trial (SPRINT) uncovered no significant increase in falls leading to injury among those participants.
Background information in the article notes that 75% of seniors older than age 75 have hypertension, although current guidelines offer inconsistent recommendations regarding the optimal systolic blood pressure (SBP) treatment target in geriatric populations.
“Some of the most vulnerable ambulatory people in the community who may suffer complications of high blood pressure can benefit from intensive blood pressure lowering, and it is safe to do so,” said lead author Jeff Williamson, MD, professor of gerontology and geriatric medicine at Wake Forest Baptist. “If you look at elderly people who are hospitalized in the year that they become disabled and have to leave their home, about half the time those diagnoses or hospitalizations result from complications of hypertension, like heart failure, stroke and heart attack.”
For the study, 2,636 participants were randomized to an intensive SBP treatment target of 120 mmHg or the standard target of SBP of 140 mmHg, excluding those with diabetes or heart failure.
At study initiation, participants had blood pressure measured three times in a quiet room, completed a walking test to determine gait speed, and responded to a questionnaire to categorize their level of frailty. Blood pressure was rechecked every 3 months and medication adjusted as needed. On average, participants in the lower blood pressure goal group required one additional medication to reach goal.
Although eight potential complications of lower blood pressure, such as hospitalizations, falls, acute kidney injury and fainting, were tracked, researchers did not find any significant difference between the two groups.
“Most of the medications used in SPRINT were generic, so this is a fairly inexpensive way to help prolong the time that people can live independently in their homes and avoid those common conditions that often cause a person to have to move to higher level of care or an institution,” Williamson added in a Wake Forest Baptist press release.
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