841 OPTIMAL BLOOD PRESSURE TO PREVENT CARDIOVASCULAR EVENTS IN THE ELDERLY HIGH-RISK HYPERTENSIVE PATIENTS

Abstract

Objective: Various treatment guidelines for hypertension recommend that blood pressure (BP) of hypertensive patients should be maintained below 140/90 mmHg. The CASE-J trial and its extension (CASE-J Ex) compared the efficts of ARB candesartan with those of CCB amlodipine on the incidence of cardiovascular events in the high-risk hypertensive patients. The present study was aimed to examine the optimal BP in the elderly high-risk hypertensive patients for the prevention of cardiovascular events as a subanalysis of the CASE-J Ex study. Method: In the CASE-J Ex study, 4,728 high-risk hypertensive patients were randomly assigned to receive either Candesartan- or Amlodipine-based treatment. We examined the relationship between the incidence of cardiovascular events and the achieved BP in each age category (<65; n = 2,176, 65- < 75; n = 1,658, ≥75; n = 719) by using the multiple Cox regression analysis with adjustment for possible confounders. Results: The mean follow-up period was 4.5 years and the follow-up rate was 97.9%. In the patients aged 65 to 74 years old, the risk of cardiovascular events significantly increased at the level of achieved systolic BP ≥ 140 mmHg and achieved diastolic BP ≥ 85 mmHg, respectively. On the contrary, in patients aged 75 to 84 years old, the risk significantly increased at the level of achieved systolic BP ≥ 150 mmHg and achieved diastolic BP ≥ 85 mmHg, respectively. Conclusion: The present study confirmed our prevois finding that for the very elderly high-risk hypertensive patients target blood pressure should be less than 150/85 mmHg.