Intensive blood pressure control targeting a systolic blood pressure (SBP) level of less than 120 mm Hg may increase mortality risk among older veterans, investigators reported at Kidney Week 2021, the virtual meeting of the American Society of Nephrology.

Investigators created a model based on blood pressure readings from 1,959,003 mostly male (96%) veterans who had high rates of chronic diseases, such as diabetes (36%), coronary artery disease (21%), chronic lung disease (15%), sleep apnea (11%), advanced chronic kidney disease (CKD; 7.7%), and atrial fibrillation (7.7%).

Having a mean SBP of less than 120 mm Hg was significantly associated with an adjusted 26% increased risk for all-cause mortality, compared with a mean SBP of 130 mm Hg or more, Diana I. Jalal, MD, Masaaki Yamada, MD, and colleagues from The University of Iowa Roy J and Lucille A Carver College of Medicine in Iowa City reported. Death risk increased with age category and was significantly stronger among veterans aged 70 years and older.

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Results from this retrospective study contrast with findings from the landmark SPRINT trial due to the different populations, use of routine office vs standardized blood pressure measurement, and other factors. Among ambulatory adults aged 75 years or older in SPRINT2, treating to an SBP target of less than 120 mm Hg compared with an SBP target of less than 140 mm Hg resulted in significantly lower rates of major cardiovascular events and death from any cause. However, half of treated patients did not attain SBP of less than 120 mm Hg.

In an interview with Renal & Urology News, Dr Yamada explained that findings from their observational study should be interpreted cautiously. “Based on the collective evidence, we believe that the current recommendations by ACC/AHA 2017 are reasonable; that is, to target a SBP of less than 130 mm Hg in elderly community dwellers, while exercising caution in those with life-limiting conditions,” Dr Yamada said.

The KDIGO 2021 guideline, however, recommends a target of systolic BP less than 120 mm Hg for those with CKD with and without diabetes, Dr Yamada continued. In addition, KDIGO stipulates that it may be harmful to target SBP less than 120 mm Hg based on non-standardized blood pressure measurements. Both guidelines acknowledge that intensive blood pressure management may not be warranted in individuals with life-limiting conditions.

“It is important for clinicians to apply the guidelines with a deep understanding of their own outpatient BP measurement procedures and to individualize treatment goals for each patient based on their patients’ overall health and treatment goals,” Dr Yamada said.


1. Yamada M, Griffin BR, Wachsmuth J, et al. Intensive blood pressure control, age, and all-cause mortality in the US Veterans Health Administration. Presented at: Kidney Week 2021; November 2-7, 2021. Abstract PO1791.

2. 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 Jun 28;315(24):2673-82. doi:10.1001/jama.2016.7050