BP Below 130 mm Hg Linked to CV Benefit in Octogenarians

TOPLINE:

Among adults aged 80 years or older on antihypertensive medications, intensive systolic blood pressure (SBP) control (below 130 mm Hg) was associated with a significantly lower risk for cardiovascular mortality than SBP of 130-160 mm Hg.

METHODOLOGY:

• Current guidelines advocate for more intensive BP control but remain inconsistent and lack strong evidence for adults aged 80 years or older.
• Researchers obtained data of 1593 adults (949 women) aged 80 years or older on antihypertensive medications from the National Health and Nutrition Examination Survey (1988-2014) to evaluate the association between SBP and cardiovascular mortality.
• SBP was measured by following the standardized protocols, and the average value of the second and third measurements was used. SBP was categorized into three groups: below 130, 130-160, and > 160 mm Hg.
• The primary outcome was cardiovascular mortality.

TAKEAWAY:

• Over a mean follow-up of 6.7 years, 46% of deaths were attributed to cardiovascular disease.
• Participants with treated SBP below 130 mm Hg had a lower risk for cardiovascular mortality than those with SBP of 130-160 mm Hg (adjusted hazard ratio, 0.74; 95% CI, 0.57-0.96).
• Sensitivity analyses, excluding deaths within 1 or 5 years or upon adjusting for frailty, showed consistent results.
• The risk for cardiovascular mortality was not significantly different between participants with SBP > 160 mm Hg and those with SBP of 130-160 mm Hg.

IN PRACTICE:

“Lower SBP is associated with lower CVD mortality in US adults aged 80+ years on antihypertensive agents, supporting guidelines for intensive BP management. Future RCTs [randomized controlled trials] are needed to clarify risks and benefits, especially at extreme SBP levels,” the authors wrote.

SOURCE:

This study was led by Huanhuan Yang, PhD, from the Yale New Haven Hospital in New Haven, Connecticut. It was published online on March 17, 2025, in the Journal of the American College of Cardiology.

LIMITATIONS:

Causal inference could not be established, and several residual confounding factors may persist despite statistical adjustments. Evaluation of long-term variability or on-medication changes in SBP was not feasible because BP was measured at only one timepoint. Additionally, complications of hypotension were not addressed in this study.

DISCLOSURES:

This study was supported by a grant from the National Heart, Lung, and Blood Institute (NHLBI). Several authors reported receiving funding from various sources, including the NHLBI, Centers for Disease Control and Prevention, Patient-Centered Outcomes Research Institute, and Sentara Research Foundation. One author reported receiving payments for advisory roles, being a co-founder of, holding equity in, and having other ties with several pharmaceutical and healthcare companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.