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

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.

Keywords: SPRINT trial; acute kidney injury; blood pressure; hypertension; hypotension; myocardial infarction; stroke.