JNC 8 (2014)
Trial Supports Intensive BP Lowering in Nondiabetic Elders
By Amy Orciari Herman
Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS
Intensive blood-pressure reduction lowers cardiovascular events and mortality in nondiabetic older adults, according to a prespecified subanalysis from SPRINT. The findings were published in JAMA and presented at the American Geriatrics Society's annual meeting.
In SPRINT, roughly 2600 adults aged 75 and older with increased CV risk but without diabetes or histories of stroke were randomized to intensive BP control (systolic target, <120 mm Hg) or standard treatment (target, <140 mm Hg). After a median 3 years' follow-up, incidence of the primary CV outcome — a composite of myocardial infarction, non-MI acute coronary syndrome, stroke, heart failure, or CV death — was 34% lower in the intensive group (102 vs. 148 events). All-cause mortality was similarly reduced with intensive treatment.
Serious adverse events did not differ between the groups. Intensive treatment was associated with more hypotension (2.4% vs. 1.4%), syncope, electrolyte abnormalities, and acute renal injury or failure (5.5% vs. 4.0%), but none of these differences were statistically significant.
Dr. Harlan Krumholz of NEJM Journal Watch Cardiology weighed in: "This remarkable subgroup analysis indicates a benefit in bringing an elderly group with an average systolic BP around 140 down to the 120s, albeit with the possibility of some risks. This strategy would represent a big shift in the approach to screening and treatment, and in my view, the findings need replication before intensive treatment can be pushed as standard of care."
LINK(S):JAMA article (Free)
JAMA editorial (Subscription required)
Background: NEJM Journal Watch General Medicine coverage of initial SPRINT results (Free)
- See more at: http://www.jwatch.org/fw111589/2016/05/20/trial-supports-intensive-bp-lowering-nondiabetic-elders?query=pfw&jwd=000101619217&jspc=GP#sthash.O3aooe0q.dpuf