INTENSIVE SYSTOLIC BLOOD PRESSURE TARGET IN OLDER HYPERTENSIVE PATIENTS - IS IT BENEFICIAL?

Abstract

Objective: The prevalence of hypertension increases with age, and the treatment in older patients is more challenging due to their comorbidities and frailty. The ideal target for systolic blood pressure (SBP) remains unclear. This study analysed how intensive blood-pressure control in older patients reflects cardiovascular events and hypertensive-mediated organ damage (HMOD) reversion. Design and method: We present a descriptive and retrospective study, including patients over 60 years, followed in a central hospital hypertension clinic over two years. One group had an SBP target < 130mmHg (intensive treatment), while the other had a more lenient target. Stroke, acute coronary syndromes, acute decompensated heart failure or death from cardiovascular causes were the evaluated cardiovascular events. The analysed HMOD included microalbuminuria, echocardiographic left ventricular hypertrophy (LVH) and chronic kidney disease (CKD). Results: 150 of 296 patients were selected. 30% were over 80 years old. Cardiovascular events occurred in 9% of patients with SBP < 130mmHg and in 7% of patients with > 130mmHg. More than half of patients (64%) had HMOD. LVH was the most frequent HMOD (78%), followed by microalbuminuria (44,8%) and CKD (37,5%). 61% of patients in intensive treatment had HMOD versus 66% with SBP target > 130mmHg. Reversion of HMOD occurred in 83% of patients with standard treatment compared with 17,6% in the intensive treatment group. Regarding previous cardiovascular events in the studied population, stroke was the most prevalent (56%), followed by acute coronary syndrome (41%). The majority (59%) of these very high cardiovascular risk patients presented an SBP target < 130mmHg. Conclusions: In this study, intensive treatment in older patients did not appear to benefit cardiovascular events prevention and HMOD reversion. However, the HMOD reversion might have been underestimated due to patient discharge prior to further evaluation. In patients with previous cardiovascular events, a tendency to select an intensive treatment seems evident.