212
Views
0
CrossRef citations to date
0
Altmetric
Review

Improving outcomes for older hypertensive patients: is more intensive treatment better?

, , , &
Pages 193-205 | Received 10 Dec 2021, Accepted 23 Mar 2022, Published online: 29 Mar 2022

References

  • NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398(10304):957–980.
  • Lewington S, Lacey B, Clarke R, et al. The burden of hypertension and associated risk for cardiovascular mortality in China. JAMA Intern Med. 2016;176(4):524–532.
  • Vasan RS, Beiser A, Seshadri S, et al. Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham Heart Study. Jama. 2002;287(8):1003–1010.
  • Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population. Results from the third national health and nutrition examination survey, 1988-1991. Hypertension. 1995;25(3):305–313.
  • Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation. 2003;107(22):2864–2869.
  • Mitchell GF, Lacourcière Y, Ouellet J-P, et al. Determinants of elevated pulse pressure in middle-aged and older subjects with uncomplicated systolic hypertension. Circulation. 2003;108(13):1592–1598.
  • Egan BM, Li J, Hutchison FN, et al. Hypertension in the United States, 1999 to 2012. Circulation. 2014;130(19):1692–1699.
  • Dodson JA, Matlock DD, Forman DE. Geriatric cardiology: an emerging discipline. Can J Cardiol. 2016;32(9):1056–1064.
  • Byrne C, Pareek M, Vaduganathan M, et al. Intensive blood pressure lowering in different age categories: insights from the systolic blood pressure intervention trial. Eur Heart J Cardiovasc Pharmacother. 2020;6(6):356–363.
  • Lewington S, Clarke R, Qizilbash N, et al., Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349): 1903–1913.
  • Port S, Demer L, Jennrich R, et al. Systolic blood pressure and mortality. Lancet. 2000;355(9199):175–180.
  • Buford TW. Hypertension and aging. Ageing Res Rev. 2016;26:96–111.
  • Hanon O, Forette F. Treatment of hypertension and prevention of dementia. Alzheimers Dement. 2005;1(1):30–37.
  • Cherubini A, Lowenthal DT, Paran E, et al. Hypertension and cognitive function in the elderly. Dis Mon. 2010;56(3):106–147.
  • Tzourio C, Dufouil C, Ducimetière P, et al. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA study group. Epidemiology of Vascular Aging. Neurology. 1999;53(9): 1948–1952.
  • Hajjar I, Lackland DT, Cupples LA, et al. Association between concurrent and remote blood pressure and disability in older adults. Hypertension. 2007;50(6):1026–1032.
  • Balzi D, Lauretani F, Barchielli A, et al. Risk factors for disability in older persons over 3-year follow-up. Age Ageing. 2010;39(1):92–98.
  • Vlachopoulos C, Jackson G, Stefanadis C, et al. Erectile dysfunction in the cardiovascular patient. Eur Heart J. 2013;34(27):2034–2046.
  • Franklin SS, Gustin W, Wong ND, et al. Hemodynamic patterns of age-related changes in blood pressure. Circulation. 1997;96(1):308–315.
  • Benetos A, Safar M, Rudnichi A, et al. Pulse pressure: a predictor of long-term cardiovascular mortality in a French male population. Hypertension. 1997;30(6):1410–1415.
  • (SHEP) SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the systolic hypertension in the elderly program. Jama. 1991;265(24):3255–3264.
  • Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet. 1997;350(9080):757–764.
  • Liu L, Wang JG, Gong L, et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic hypertension in China (Syst-China) collaborative group. J Hypertens. 1998;16(12 Pt 1):1823–1829.
  • Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887–1898.
  • Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The systolic hypertension in Europe (Syst-Eur) trial investigators. Lancet. 1997;350(9080):757–764.
  • Warwick J, Falaschetti E, Rockwood K, et al. No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the hypertension in the very elderly trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over. BMC Med. 2015;13:78.
  • Members ATF, Mancia G, Fagard R, et al. ESH/ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). Eur Heart J. 2013;34(28):2159–2219.
  • Benetos A, Bulpitt CJ, Petrovic M, et al. An expert opinion from the European society of hypertension–European union geriatric medicine society working group on the management of hypertension in very old, frail subjects. Hypertension. 2016;67(5):820–825.
  • Vidal-Petiot E, Ford I, Greenlaw N, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet. 2016;388(10056):2142–2152.
  • Böhm M, Schumacher H, Teo KK, et al. Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk. Eur Heart J. 2019;40(25):2032–2043.
  • Blanco PJ, Müller LO, Spence JD. Blood pressure gradients in cerebral arteries: a clue to pathogenesis of cerebral small vessel disease. Stroke Vasc Neurol. 2017;2(3):108–117.
  • Leung AA, Daskalopoulou SS, Dasgupta K, et al. Hypertension Canada’s 2017 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Can J Cardiol. 2017;33(5):557–576.
  • Whelton PK, Carey RM, Aronow WS, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2017;71(19):e127–e248. (2018).
  • Williams B, Mancia G, Spiering W, et al. ESC/ESH Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of cardiology (ESC) and the European society of hypertension (ESH). Eur Heart J. 2018;39(33):3021–3104.
  • Qaseem A, Wilt TJ, Rich R, et al. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American college of physicians and the American academy of family physicians. Ann Intern Med. 2017;166(6):430–437.
  • World Health Organization. WHO Guidelines approved by the guidelines review committee, in guideline for the pharmacological treatment of hypertension in adults. 2021. World Health Organization© World Health Organization: Geneva.
  • Zanchetti A, Thomopoulos C, Parati G. Randomized controlled trials of blood pressure lowering in hypertension: a critical reappraisal. Circ Res. 2015;116(6):1058–1073.
  • Liu L, Zhang Y, Liu G, et al. The Felodipine Event Reduction (FEVER) study: a randomized long-term placebo-controlled trial in Chinese hypertensive patients. J Hypertens. 2005;23(12):2157–2172.
  • Zhang Y, Zhang X, Liu L, et al. Is a systolic blood pressure target <140 mmHg indicated in all hypertensives? Subgroup analyses of findings from the randomized FEVER trial. Eur Heart J. 2011;32(12):1500–1508.
  • Yusuf S, Lonn E, Pais P, et al., Blood-pressure and cholesterol lowering in persons without cardiovascular disease. N Engl J Med. 2016; 374(21):2032–2043.
  • Yusuf S, Bosch J, Dagenais G, et al. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374(21):2021–2031.
  • Lonn EM, Bosch J, López-Jaramillo P, et al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374(21):2009–2020.
  • Bosch J, Lonn EM, Jung H, et al. Lowering cholesterol, blood pressure, or both to prevent cardiovascular events: results of 8.7 years of follow-up of Heart Outcomes Evaluation Prevention (HOPE)-3 study participants. Eur Heart J. 2021;42(31):2995–3007.
  • Böhm M, Schumacher H, Teo KK, et al., Achieved diastolic blood pressure and pulse pressure at target systolic blood pressure (120-140 mmHg) and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Eur Heart J. 2018;39(33):3105–3114.
  • ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358(15):1547–1559.
  • Yusuf S, Teo K, Anderson C, et al. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet. 2008;372(9644):1174–1183.
  • Wright JT Jr., Williamson JD, Whelton PK, et al., A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–2116.
  • Williamson JD, Supiano MA, Applegate WB, et al., Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. Jama. 2016;315(24): 2673–2682.
  • Zhang W, Zhang S, Deng Y, et al., Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med. 2021;385(14):1268–1279.
  • Cushman WC, Evans GW, Byington RP, et al., Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575–1585.
  • JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res. 2008;31(12):2115–2127.
  • Verdecchia P, Staessen JA, Angeli F, et al. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial. Lancet. 2009;374(9689):525–533.
  • Ogihara T, Saruta T, Rakugi H, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study. Hypertension. 2010;56(2):196–202.
  • Benavente OR, Coffey CS, Conwit R, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382(9891):507–515.
  • Appel LJ, Wright JT, Greene T, et al. Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med. 2010;363(10):918–929.
  • Rocco MV, Sink KM, Lovato LC, et al. Effects of intensive blood pressure treatment on acute kidney injury events in the Systolic Blood Pressure Intervention Trial (SPRINT). Am J Kidney Dis. 2018;71(3):352–361.
  • Shapiro BP, Ambrosius WT, Blackshear JL, et al. Impact of intensive versus standard blood pressure management by tertiles of blood pressure in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71(6):1064–1074.
  • Beddhu S, Chertow GM, Cheung AK, et al. Influence of baseline diastolic blood pressure on effects of intensive compared with standard blood pressure control. Circulation. 2018;137(2):134–143.
  • Derington CG, Gums TH, Bress AP, et al. Association of total medication burden with intensive and standard blood pressure control and clinical outcomes: a secondary analysis of SPRINT. Hypertension. 2019;74(2):267–275. Hypertensionaha11912907.
  • Cheung AK, Rahman M, Reboussin DM, et al. Effects of intensive BP control in CKD. J Am Soc Nephrol. 2017;28(9):2812–2823.
  • Bress AP, Greene T, Derington CG, et al. Patient selection for intensive blood pressure management based on benefit and adverse events. J Am Coll Cardiol. 2021;77(16):1977–1990.
  • Lewis CE, Fine LJ, Beddhu S, et al. Final report of a trial of intensive versus standard blood-pressure control. N Engl J Med. 2021;384(20):1921–1930.
  • Perkovic V, Rodgers A. Redefining blood-pressure targets–SPRINT starts the marathon. N Engl J Med. 2015;373(22):2175–2178.
  • Drazen JM, Morrissey S, Campion EW, et al. A SPRINT to the finish. N Engl J Med. 2015;373(22):2174–2175.
  • Johnson KC, Whelton PK, Cushman WC, et al. Blood pressure measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71(5):848–857.
  • Edwards C, Hiremath S, Gupta A, et al. BpTRUth: do automated blood pressure monitors outperform mercury? J Am Soc Hypertens. 2013;7(6):448–453.
  • Culleton BF, McKay DW, Campbell NR. Performance of the automated BpTRU measurement device in the assessment of white-coat hypertension and white-coat effect. Blood Press Monit. 2006;11(1):37–42.
  • Zhang S, Wu S, Ren J, et al. Strategy of blood pressure intervention in the elderly hypertensive patients (STEP): rational, design, and baseline characteristics for the main trial. Contemp Clin Trials. 2020;89:105913.
  • Nelson MR. Moving the goalposts for blood pressure - time to act. N Engl J Med. 2021;385(14):1328–1329.
  • Verdecchia P, Staessen JA, Angeli F, et al. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial. Lancet. 2009;374(9689):525–533.
  • Rakugi H, Ogihara T, Goto Y, et al. Comparison of strict- and mild-blood pressure control in elderly hypertensive patients: a per-protocol analysis of JATOS. Hypertens Res. 2010;33(11):1124–1128.
  • Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.
  • Ettehad D, Emdin CA, Kiran A, et al., Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 387(10022): 957–967. 2016.
  • Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387(10017):435–443.
  • Bundy JD, Li C, Stuchlik P, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol. 2017;2(7):775–781.
  • Blood Pressure Lowering Treatment Trialists' Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet. 2021;398(10305):1053–1064.
  • Williamson JD, Pajewski NM, Auchus AP, et al. Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. Jama. 2019;321(6):553–561.
  • Nasrallah IM, Pajewski NM, Auchus AP, et al. Association of intensive vs standard blood pressure control with cerebral white matter lesions. Jama. 2019;322(6):524–534.
  • White WB, Wakefield DB, Moscufo N, et al. Effects of intensive versus standard ambulatory blood pressure control on cerebrovascular outcomes in older people (INFINITY). Circulation. 2019;140(20):1626–1635.
  • Bosch J, O’Donnell M, Swaminathan B, et al. Effects of blood pressure and lipid lowering on cognition: results from the HOPE-3 study. Neurology. 2019;92(13):e1435–e46.
  • Moll van Charante EP, Richard E, Eurelings LS, et al. Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. Lancet. 2016;388(10046):797–805.
  • Peters R, Beckett N, Forette F, et al. Incident dementia and blood pressure lowering in the hypertension in the very elderly trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol. 2008;7(8):683–689.
  • Messerli FH, Bangalore S, Messerli AW, et al. Blood pressure targets, and guidelines. Circulation. 2018;138(2):128–130.
  • Benetos A, Labat C, Rossignol P, et al. Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: the partage study. JAMA Intern Med. 2015;175(6):989–995.
  • Boshuizen HC, Izaks GJ, van Buuren S, et al. Blood pressure and mortality in elderly people aged 85 and older: community based study. Bmj. 1998;316(7147):1780–1784.
  • van Hateren KJ, Landman GW, Kleefstra N, et al. Lower blood pressure associated with higher mortality in elderly diabetic patients (ZODIAC-12). Age Ageing. 2010;39(5):603–609.
  • Aparicio LS, Thijs L, Boggia J, et al. Defining thresholds for home blood pressure monitoring in octogenarians. Hypertension. 2015;66(4):865–873.
  • Streit S, Poortvliet RKE, Gussekloo J, et al. Lower blood pressure during antihypertensive treatment is associated with higher all-cause mortality and accelerated cognitive decline in the oldest-old. Data from the leiden 85-plus study. Age Ageing. 2018;47(4):545–550.
  • Appel LJ, J.T.Wright TG Jr. Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med. 2010;363(10):918–929.
  • Klag MJ, Whelton PK, Randall BL, et al. End-stage renal disease in African-American and white men: 16-year MRFIT findings. JAMA. 1997;277(16):1293–1298.
  • Appel LJ, Wright Jr, JT, Greene T, et al. Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med. 2010;363(26):2564–2566.
  • Zoungas S, Chalmers J, Neal B, et al. Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N Engl J Med. 2014;371(15):1392–1406.
  • Patel A, MacMahon S, Chalmers J, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet. 2007;370(9590):829–840.
  • Estacio RO, Jeffers BW, Hiatt WR, et al. The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med. 1998;338(10):645–652.
  • Buckley LF, Dixon DL, Wohlford GFT, et al. Intensive versus standard blood pressure control in SPRINT-eligible participants of ACCORD-BP. Diabetes Care. 2017;40(12):1733–1738.
  • Tsujimoto T, Kajio H. Benefits of intensive blood pressure treatment in patients with type 2 diabetes mellitus receiving standard but not intensive glycemic control. Hypertension. 2018;72(2):323–330.
  • Zhang WR, Craven TE, Malhotra R, et al. Kidney damage biomarkers and incident chronic kidney disease during blood pressure reduction: a case-control study. Ann Intern Med. 2018;169(9):610–618.
  • Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality: 13 - benefits and adverse events in older and younger patients with hypertension: overview, meta-analyses and meta-regression analyses of randomized trials. J Hypertens. 2018;36(8):1622–1636.
  • Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet. 2013;381(9868):752–762.
  • Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American geriatrics society/national institute on aging research conference on frailty in older adults. J Am Geriatr Soc. 2006;54(6):991–1001.
  • Lowenstein F. Blood-pressure in relation to age and sex in the tropics and subtropics: a review of the literature and an investigation in two tribes of Brazil Indians. Lancet. 1961;277(7173):389–392.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.