Intensive Blood Pressure Control and Cardiovascular Outcomes in Elderly Patients: A Secondary Analysis of SPRINT Study Based on a 60-Year Age Cutoff

Abstract

Abstract Background In the original SPRINT article, age was categorized at 75 years, which was contrary to many previous clinical trials which is at 60 years. Methods The SPRINT trial randomized 9,361 hypertensive patients to a target blood pressure of <120 vs. <140 mm Hg (intensive vs. standard treatment, respectively). Age was re-categorized as <60 and ≥60 years and hazard ratios (HRs) were calculated with 95% confidence intervals (CIs) for outcomes and adverse events. Results Intensive treatment reduced primary outcome significantly in both <60 and ≥60 years of age subgroups with a relative risk reduction (RRR) of 36% and 22%, respectively, and HR of 0.58 [95% CI, 0.36–0.94] and 0.78 [95% CI, 0.65–0.93], respectively. Although the intensive treatment rendered no effect on myocardial infarction (MI) in the overall comparison, it significantly reduced MI in patients <60 years of age with an RRR of 58% and HR of 0.39 [95% CI, 0.17–0.91]. In the ≥60-year age subgroup, reduced heart failure incidence was noted after intensive treatment, including death from other cardiovascular causes; however, these were not observed in the <60-year age subgroup. Intensive treatment resulted in significant hypotension, syncope, acute renal failure, or acute kidney injury in the ≥60-year age group; conversely, the risk of these adverse effects in patients <60 years of age did not increase. Conclusions Intensive blood pressure control is beneficial for elderly patients (age ≥60 years), albeit with increased risk of adverse events.