Benefits and Harms of Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older: A Systematic Review and Meta-analysis

Jessica Weiss, Michele Freeman, Allison Low, Rongwei (Rochelle) Fu, Amy Kerfoot, Robin Paynter, Makalapua Motu'apuaka, Karli Kondo, Devan Kansagara

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Abstract

Background: Recent guidelines recommend a systolic blood pressure (SBP) goal of less than 150 mm Hg for adults aged 60 years or older, but the balance of benefits and harms is unclear in light of newer evidence.

Purpose: To systematically review the effects of more versus less intensive BP control in older adults.

Data Sources: Multiple databases through January 2015 and MEDLINE to September 2016.

Study Selection: 21 randomized, controlled trials comparing BP targets or treatment intensity, and 3 observational studies that assessed harms.

Data Extraction: Two investigators extracted data, assessed study quality, and graded the evidence using published criteria.

Data Synthesis: Nine trials provided high-strength evidence that BP control to less than 150/90 mm Hg reduces mortality (relative risk [RR], 0.90 [95% CI, 0.83 to 0.98]), cardiac events (RR, 0.77 [CI, 0.68 to 0.89]), and stroke (RR, 0.74 [CI, 0.65 to 0.84]). Six trials yielded low- to moderate-strength evidence that lower targets (≤140/85 mm Hg) are associated with marginally significant decreases in cardiac events (RR, 0.82 [CI, 0.64 to 1.00]) and stroke (RR, 0.79 [CI, 0.59 to 0.99]) and nonsignificantly fewer deaths (RR, 0.86 [CI, 0.69 to 1.06]). Low- to moderate-strength evidence showed that lower BP targets do not increase falls or cognitive impairment.

Limitation: Data relevant to frail elderly adults and the effect of multimorbidity are limited.

Conclusion: Treatment to at least current guideline standards for BP (<150/90 mm Hg) substantially improves health outcomes in older adults. There is less consistent evidence, largely from 1 trial targeting SBP less than 120 mm Hg, that lower BP targets are beneficial for high-risk patients. Lower BP targets did not increase falls or cognitive decline but are associated with hypotension, syncope, and greater medication burden.

Primary Funding Source: U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. (PROSPERO 2015: CRD42015017677).

Original languageEnglish (US)
Pages (from-to)419-429
Number of pages11
JournalAnnals of Internal Medicine
Volume166
Issue number6
DOIs
StatePublished - Mar 21 2017

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Meta-Analysis
Blood Pressure
United States Department of Veterans Affairs
Stroke
Guidelines
Veterans Health
Frail Elderly
Information Storage and Retrieval
Syncope
Research
MEDLINE
Hypotension
Observational Studies
Comorbidity
Randomized Controlled Trials
Research Personnel
Databases
Mortality
Health
Therapeutics

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Benefits and Harms of Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older : A Systematic Review and Meta-analysis. / Weiss, Jessica; Freeman, Michele; Low, Allison; Fu, Rongwei (Rochelle); Kerfoot, Amy; Paynter, Robin; Motu'apuaka, Makalapua; Kondo, Karli; Kansagara, Devan.

In: Annals of Internal Medicine, Vol. 166, No. 6, 21.03.2017, p. 419-429.

Research output: Contribution to journalArticle

Weiss, Jessica ; Freeman, Michele ; Low, Allison ; Fu, Rongwei (Rochelle) ; Kerfoot, Amy ; Paynter, Robin ; Motu'apuaka, Makalapua ; Kondo, Karli ; Kansagara, Devan. / Benefits and Harms of Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older : A Systematic Review and Meta-analysis. In: Annals of Internal Medicine. 2017 ; Vol. 166, No. 6. pp. 419-429.
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AU - Freeman, Michele

AU - Low, Allison

AU - Fu, Rongwei (Rochelle)

AU - Kerfoot, Amy

AU - Paynter, Robin

AU - Motu'apuaka, Makalapua

AU - Kondo, Karli

AU - Kansagara, Devan

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