Investigators have quantified the lag time to benefit after intensive blood pressure treatment in older adults aged 60 years and older with hypertension.
In analyses of data from 6 randomized trials involving 27,414 older patients, intensive hypertension treatment to a systolic blood pressure target less than 140 mm Hg was significantly associated with a 21% reduction in the risk for major adverse cardiovascular events (MACE). MACE was variably defined across trials but always included myocardial infarction, stroke, and cardiovascular death.
To prevent 1 MACE, 500 patients would need to be treated for 9.1 months, 200 patients would need to be treated for 19.1 months, and 100 patients would need to be treated for 34.4 months, with increasing absolute risk reduction, Chao Li, PhD, of Xi’an Jiaotong University Health Science Center in China, and colleagues reported in JAMA Internal Medicine. According to the investigators, intensive blood pressure treatment may be appropriate in older adults with life expectancies that exceed these lag times. Older adults with more than 3 years of life expectancy may reap a benefit from intensive treatment but probably not those with a life expectancy less than 1 year, they reported. The potential cardiovascular benefit also needs to be weighed against a patient’s risk for immediate harms from aggressive treatment, such as acute kidney injury, electrolyte abnormalities, hypotension, syncope, and falls.
Guidelines differ in the blood pressure target for intensive blood pressure control, with some advocating a target systolic blood pressure less than 150 mm Hg and others less than 140, 130, and 120 mm Hg.
“Even though the treatment thresholds differ between guidelines, clinicians are advised to determine BP targets based on a thorough review of comorbidities and patients’ life expectancy,” according to Dr Li’s team. “A framework for individualizing prevention decisions incorporating [time to benefit] is being increasingly discussed. Analyzing and reporting this measurement would add more information about treatment effectiveness to clinicians’ evidence base.”
Chen T, Shao F, Chen K, et al. Time to clinical benefit of intensive blood pressure lowering in patients 60 years and older with hypertension: a secondary analysis of randomized clinical trials. JAMA Intern Med. Published online May 9, 2022. doi:10.1001/jamainternmed.2022.1657