New evidence on hypertension targets in elderly

The ‘research update’ section in the BMJ alerted me to an interesting study in JAMA – the SPRINT study, comparing different hypertension targets in relatively healthy elderly people. Here’s the information I have from the abstract plus editorial:

Population studied

  • >75 (average age when numbers crunched was almost 80)
  • Ambulatory and living in community
  • Systolic BP initially between 130 and 180
  • Non-diabetic
  • No history of CCF
  • No history of CVA
  • Didn’t have postural hypotension – measured in this case as systolic BP remaining >110 after 1 minute standing.

Intervention

Patients randomised to a standard treatment group in which the target was to get their systolic BP below 140, and an intensive treatment group in which the goal was <120.

Results

Average systolic BP achieved in the intensive control group was actually 123. Despite this, rates both of composite cardiovascular events (MI, CVA, ACS, and acute decompensated heart failure) and of overall mortality was almost 50% higher in the ‘standard treatment’ group at just over . If the numbers on whom follow-up was obtained were roughly equivalent between the two groups (which isn’t made clear in the abstract) then the NNT would be approximately 27 to avoid a cardiovascular event or CVA, and 37 to avoid one death in that time. However, adverse events (including hypotension, falls with injury, electrolyte imbalance, AKI) were approximately equal between the two groups.

This would, as Richard Lehman pointed out on the BMJ, mean 75% of the over-75s should potentially be on antihypertensives (I’m not sure if that’s actually 75% of the total number or 75% of the subset of >75s who fit the above criteria) which does seem somewhat excessive. More to the point, I’d be worried about the possible SEs if this study is wrong – I’d ideally like to see it confirmed by one more before extolling the virtues of tighter BP control to my patients. But it’s still useful information and worth mentioning.

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Credits 2016, Elderly Medicine, Hypertension. Bookmark the permalink.

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