17. Intensive vs. Standard Blood Pressure Strategy in Elderly Patients: A Systematic Review and Meta-analysis

Abstract

Background and Objectives: Currently, ESC and AHA have different blood pressure (BP) goals, particularly for elderly patients. This study compared efficacy and side effect of intensive BP-lowering strategies in elderly (age $60 years) hypertensive patients. Methods: We searched PubMed, ProQuest, Google Scholar, and Cochrane database for all Randomized Control Trials (RCTs). Studies that compare the outcome of intensive vs. standard BP strategy in the elderly hypertensive patient were included. All-cause death, Acute Myocardial Infarction (AMI), cardiovascular (CV) death, Heart Failure (HF), stroke, injurious fall/fracture, and syncope were evaluated. We did a subgroup analysis in elderly hypertensive patients (>70 years old) with no comorbidities. Random effect analysis was used to calculate pooled relative risk (RRs) and 95% confidence intervals (Cis). Results: This study includes 7 RCTs with 19.650 patients. Intensive BP showed significant differences from standard BP to all-cause death (RR: 0.74; 95% CI: 0.58 - 0.93; P = 0.01), AMI (RR: 0.72; 95% CI: 0.57 - 0.92: P = 0.008), CV death (RR: 0.63; 95%CI: 0.47 - 0.84; P = 0.001), HF (RR: 0.61; 95% CI: 0.42 - 0.89; P = 0.01), and stroke (RR: 0.72; 95% CI: 0.55 - 0.95; P = 0.02). In the subgroup analysis of 3 RCTs with 6.439 patients, intensive BP significantly reduce all-cause death (RR: 0.66; 95% CI: 0.54 to 0.80; P = 0.0001), CV death (RR: 0.60; 95%CI: 0.43 to 0.84; P = 0.003), and stroke (RR: 0.62; 95% CI: 0.39 to 0.99; P = 0.04). Conclusions: Intensive BP strategy in older patients reduces all-cause death, AMI, CV death, HF, and stroke event.