Risk of Death Among OAs With Low BP

Lower blood pressure (BP) is associated with an increased risk of death in adults over 80 years old and those with a history of heart attack or stroke, according to the results of a recent study.

There has been debate over appropriate BP targets in patients aged 75 years with hypertension, with 2017 ACC/AHA guidance recommending systolic BP <130 mmHg and ESC/ESH guidance on the treatment of arterial hypertension recommending a target of <140 mmHg.

In order to assess the effects of targeting systolic BP below 140 mmHg and diastolic BP below 90 mmHg during antihypertensive treatment, the researchers assembled a cohort of 1628 patients from the Berlin Initiative Study aged 70 years or older treated with antihypertensive drugs.

During 8853 person-years of follow-up, 469 patients died. Compared with non-normalized BP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg), those with normalized BP (systolic BP <140 mmHg and diastolic BP <90 mmHg) had an increased risk of all-cause mortality (incidence rates 60.3 vs 48.5 per 1000/year; hazard ratio [HR] 1.26).

Further, increased risk was observed in patients aged 80 years or older (102.2 vs. 77.5 per 1000/year; HR 1.40) and those with a history of cardiovascular events ((98.3 vs. 63.6 per 1000/year; HR 1.61), but not in patients aged 70 to 79 years or those without a history of cardiovascular events.

“In summary, our study shows that BP values below 140/90 mmHg could be associated with an increased risk of all-cause mortality in those aged 80 years or older or at increased cardiovascular risk, with the number needed to harm being relatively low,” the researchers concluded.

“Given the scarcity of RCTs in elderly populations and the challenges regarding the generalization of their results in real-world clinical practice, careful individualized clinical assessment of potential benefits, and harms of antihypertensive treatment should guide physician decision-making.”

—Michael Potts

Reference:

Douros A, Tolle M, Ebert N, et al. Control of blood pressure and risk of mortality in a cohort of older adults: the Berlin Initiative Study [published online February 25, 2019]. European Heart Journal. https://doi.org/10.1093/eurheartj/ehz071