Intensive Blood Pressure Control Reduces Cardiovascular Risks In Older Adults

Intensive blood pressure control in older adults is associated with decreased incidences of major adverse cardiovascular events (MACE), but could be associated with increased risk for renal failure, according to a recent meta-analysis.

The meta-analysis included 4 high-quality trials that involved 10,857 older patients with hypertension. The mean follow-up was 3.1 years. Safety of intensive blood pressure (BP) control was assessed using serious adverse events and renal failure as outcomes. Pooled relative risks were calculated using random and fixed effects analysis.
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Their findings showed that intensive BP lowering was associated with a 29% reduction of MACE, 33% reduction in cardiovascular mortality, and 37% reduction in heart failure compared to standard BP lowering treatment. The meta-analysis did not show any differences in rates for myocardial infarction and stroke between standard and intensive BP treatment groups, and no significant differences in incidences of serious adverse events or renal failure.

A fixed effects analysis yielded similar results, except for a 2-fold increase in risk for renal failure in patients undergoing intensive BP-lowering treatment.

“When interpreting the risks and benefits of intensive therapy, some numbers should be taken into perspective,” the researchers stated.

While intensive therapy showed benefit, the study found that patients on intensive treatment used a higher amount of antihypertensive medications. Likewise, the intensity of treatment might vary, and the high dosages needed to achieve the desired BP level could increase adverse effects substantially.

“More importantly, older patients have a higher burden of comorbidities and are often exposed to polypharmacy, which may further potentiate the risk of adverse events,” the researchers wrote.

Additional studies are needed to investigate the effects of intensive BP control on renal function and other serious adverse events, and additional long-term health outcomes in patients, they noted.

“When considering more intensive BP control in the elderly, clinicians should carefully balance benefits against potential risks,” they concluded.

—Melissa Weiss

Reference:

Bavishi C, Bangalore S, and Messerli FH. Outcomes of intensive blood pressure lowering in older hypertension patients [published online before print  January 30, 2017]. Journal of the American College of Cardiology. doi:10.1016/j.jacc.2016.10.077.