If you have high blood pressure, lowering it is one of the most important things you can do to reduce your risk of cardiovascular disease (CVD). This is especially important for the elderly, since 70 percent of people ages 65 and older have hypertension, according to the American College of Cardiology. That number is expected to rise as the population ages.

How Low Do You Go?

Experts all agree that treating hypertension in seniors reduces the risk of death from CVD—the big question is, how low do you go? The most important number for lowering blood pressure is the higher systolic number. This is the pressure inside arteries when your heart beats. It is measured in millimeters of mercury (mmHg). These are the current hypertension treatment guidelines for the systolic number…

  • 130 mmHg or less (American Heart Association and American College of Cardiology)
  • 140 mmHg or less (The European Society of Cardiology and European Society of Hypertension)
  • 150 mmHg or less (American College of Physicians and American Academy of Family Physicians)

A 2015 study, called the Systolic Blood Pressure Intervention Trial (SPRINT), found intensive treatment to get the systolic blood pressure under 130 mmHg in hypertensive patients at or over age 65 improved risk for CVD. Now, researchers from China support the SPRINT study, confirming lower is better.

The aim of the study was to find the appropriate target for systolic blood pressure to reduce CVD risk in older patients with hypertension, a number that has remained unclear. The study was published in The New England Journal of Medicine and was also presented at the 2021 meeting of the European Society of Cardiology.

This was a large trial conducted at many treatment centers in which patients were randomly selected to receive standard or intensive blood pressure treatment. There were about 8,500 patients in the trial, and they were about equally divided into the two treatment groups. The age of the patients ranged from 60 to 80.

Lower Systolic Numbers Mean Fewer Heart Attacks

The primary goal of the study was to see which treatment group had fewer CVD events. CVD events included stroke, heart attack, hospital admission for angina, heart failure, a procedure to open a heart artery (coronary revascularization), atrial fibrillation or death from any CVD cause.

In the intensive treatment group, the goal was a systolic blood pressure from 110 to under 130 mmHg. In the standard treatment group, the goal was a systolic blood pressure from 130 to under 150 mmHg. These were the key findings…

  • After one year, the mean systolic pressure in the standard-treatment group was 135.3 mm Hg.
  • After one year, the mean systolic pressure in the intensive-treatment group was 127.5 mm Hg.
  • At three to four years, between 3.5 to 4.6 percent of all the patients in the study had a CVD event.
  • The risk of a CVD event was about 25 percent lower in the intensive-treatment group compared to the standard-treatment group.

The corresponding author of the Chinese study says that these findings and the SPRINT study could unite the guidelines to recommend a lower target for systolic blood pressure in elderly people with hypertension.

For ways to reduce high blood pressure: Visit the American Heart Association website at Heart.org/en/health-topics/high-blood-pressure/commit-to-a-plan-to-lower-your-blood-pressure/lower-numbers-start-here

Source: Study titled “Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension,” by researchers at the Chinese Academy of Medical Sciences, et al., published in The New England Journal of Medicine.

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