Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial
Nicholas M Pajewski, Dan R Berlowitz, Adam P Bress, Kathryn E Callahan, Alfred K Cheung, Larry J Fine, Sarah A Gaussoin, Karen C Johnson, Jordan King, Dalane W Kitzman, John B Kostis, Alan J Lerner, Cora E Lewis, Suzanne Oparil, Mahboob Rahman, David M Reboussin, Michael V Rocco, Joni K Snyder, Carolyn Still, Mark A Supiano, Virginia G Wadley, Paul K Whelton, Jackson T Wright Jr,, Jeff D Williamson, Nicholas M Pajewski, Dan R Berlowitz, Adam P Bress, Kathryn E Callahan, Alfred K Cheung, Larry J Fine, Sarah A Gaussoin, Karen C Johnson, Jordan King, Dalane W Kitzman, John B Kostis, Alan J Lerner, Cora E Lewis, Suzanne Oparil, Mahboob Rahman, David M Reboussin, Michael V Rocco, Joni K Snyder, Carolyn Still, Mark A Supiano, Virginia G Wadley, Paul K Whelton, Jackson T Wright Jr,, Jeff D Williamson
Abstract
Objectives: To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function.
Design: Secondary analysis.
Setting: Systolic Blood Pressure Intervention Trial (SPRINT) PARTICIPANTS: Adults 80 years or older.
Intervention: Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment).
Measurements: We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4-m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function.
Results: Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49-.90), mortality (HR = .67; 95% CI = .48-.93), and MCI (HR = .70; 95% CI = .51-.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28-.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87-2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between-group differences in the rate of injurious falls.
Conclusion: In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function.
Trial registration: Clinicaltrials.gov identifier: NCT01206062. J Am Geriatr Soc 68:496-504, 2020.
Keywords: cardiovascular disease; cognitive function; hypertension; older adults.
Conflict of interest statement
Conflicts of Interest: All authors received support for this work from the NIH. Adam P. Bress receives research support to his institution from Novartis, Amgen, and Amarin. Jordan King has received private consulting income from Novartis and Amarin. Suzanne Oparil reported receipt of personal fees from Actelion Clinical Research, Boehringer Ingelheim/Lilly, Lundbeck, Novo Nordisk, 98point6, George Clinical Pty, Idorsia Pharmaceuticals, Pfizer, and ROX Medical, and grant support from Actelion Clinical Research, George Clinical Pty, Idorsia Pharmaceuticals, and Novartis. She also reported work as editor in chief of Current Hypertension Reports (until December 2020), published by Springer Science Business Media, for which she receives an annual stipend of $5000. JeffD. Williamson reported that his institution received funding from Biogen (unrelated to this study).
© 2019 The American Geriatrics Society.
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Source: PubMed