Intensive Systolic BP Control May Not Benefit All Older Adults
No real benefit seen for adults ≥80 years with lower cognitive function
MONDAY, Jan. 13, 2020 (HealthDay News) -- Intensive systolic blood pressure (SBP) control lowers the risk for major cardiovascular events, cognitive impairment, and death in older adults; however, these benefits may not extend to older adults with lower baseline cognitive function, according to a study published online Dec. 16 in the Journal of the American Geriatrics Society.
Nicholas M. Pajewski, Ph.D., from the Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues evaluated the effect of intensive SBP control in older adults (≥80 years) with hypertension on both cognitive and physical function. Participants were randomly assigned to either an SBP target of <120 mm Hg (intensive treatment) or <140 mm Hg (standard treatment).
The researchers found that intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR], 0.66; 95 percent confidence interval [CI], 0.49 to 0.90), mortality (HR, 0.67; 95 percent CI, 0.48 to 0.93), and mild cognitive impairment (HR, 0.70; 95 percent CI, 0.51 to 0.96). Participants with higher baseline scores on the Montreal Cognitive Assessment showed the strongest benefit from intensive treatment for a composite of cardiovascular disease and mortality (HR, 0.40; 95 percent CI, 0.28 to 0.57), but no benefit was seen among participants with lower scores (HR, 1.33; 95 percent CI, 0.87 to 2.03). While rates of acute kidney injury were increased in the intensive treatment group, there were no differences between the groups for rate of injurious falls.
"In conclusion, in adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, mild cognitive impairment, and death, with increased risk of changes to kidney function," the authors write. "The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower cognitive function."
Several authors disclosed financial ties to the pharmaceutical industry.