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Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial.
J Am Geriatr Soc. 2020 03; 68(3):496-504.JA

Abstract

OBJECTIVES

To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function.

DESIGN

Secondary analysis.

SETTING

Systolic Blood Pressure Intervention Trial (SPRINT) PARTICIPANTS: Adults 80 years or older.

INTERVENTION

Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment).

MEASUREMENTS

We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4-m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function.

RESULTS

Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49-.90), mortality (HR = .67; 95% CI = .48-.93), and MCI (HR = .70; 95% CI = .51-.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28-.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87-2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between-group differences in the rate of injurious falls.

CONCLUSION

In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT01206062. J Am Geriatr Soc 68:496-504, 2020.

Links

PMC Free PDF

Authors+Show Affiliations

Pajewski NM
Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Berlowitz DR
Bedford Veterans Affairs Hospital, Bedford, Massachusetts. Department of Public Health, University of Massachusetts Lowell, Lowell, Massachusetts.
Bress AP
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah.
Callahan KE
Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Cheung AK
Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, Utah.
Fine LJ
Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Gaussoin SA
Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Johnson KC
Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
King J
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah. Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado.
Kitzman DW
Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Kostis JB
Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Lerner AJ
Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Lewis CE
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
Oparil S
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Rahman M
Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio.
Reboussin DM
Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Rocco MV
Section of Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Snyder JK
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Still C
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.
Supiano MA
Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, Utah. Geriatric Research, Education, and Clinical Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
Wadley VG
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Whelton PK
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
Wright JT
Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
Williamson JD
Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.

MeSH

Acute Kidney InjuryAged, 80 and overBlood PressureCardiovascular DiseasesCognitive DysfunctionFemaleHumansHypertensionIncidenceMaleMental Status and Dementia TestsRandomized Controlled Trials as Topic

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

31840813

Clinical Trial Links

Clinical trial which this article describes

Citation

Pajewski, Nicholas M., et al. "Intensive Vs Standard Blood Pressure Control in Adults 80 Years or Older: a Secondary Analysis of the Systolic Blood Pressure Intervention Trial." Journal of the American Geriatrics Society, vol. 68, no. 3, 2020, pp. 496-504.
Pajewski NM, Berlowitz DR, Bress AP, et al. Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial. J Am Geriatr Soc. 2020;68(3):496-504.
Pajewski, N. M., Berlowitz, D. R., Bress, A. P., Callahan, K. E., Cheung, A. K., Fine, L. J., Gaussoin, S. A., Johnson, K. C., King, J., Kitzman, D. W., Kostis, J. B., Lerner, A. J., Lewis, C. E., Oparil, S., Rahman, M., Reboussin, D. M., Rocco, M. V., Snyder, J. K., Still, C., ... Williamson, J. D. (2020). Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial. Journal of the American Geriatrics Society, 68(3), 496-504. https://doi.org/10.1111/jgs.16272
Pajewski NM, et al. Intensive Vs Standard Blood Pressure Control in Adults 80 Years or Older: a Secondary Analysis of the Systolic Blood Pressure Intervention Trial. J Am Geriatr Soc. 2020;68(3):496-504. PubMed PMID: 31840813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial. AU - Pajewski,Nicholas M, AU - Berlowitz,Dan R, AU - Bress,Adam P, AU - Callahan,Kathryn E, AU - Cheung,Alfred K, AU - Fine,Larry J, AU - Gaussoin,Sarah A, AU - Johnson,Karen C, AU - King,Jordan, AU - Kitzman,Dalane W, AU - Kostis,John B, AU - Lerner,Alan J, AU - Lewis,Cora E, AU - Oparil,Suzanne, AU - Rahman,Mahboob, AU - Reboussin,David M, AU - Rocco,Michael V, AU - Snyder,Joni K, AU - Still,Carolyn, AU - Supiano,Mark A, AU - Wadley,Virginia G, AU - Whelton,Paul K, AU - Wright,Jackson T,Jr, AU - Williamson,Jeff D, Y1 - 2019/12/16/ PY - 2019/08/06/received PY - 2019/10/29/revised PY - 2019/11/01/accepted PY - 2019/12/17/pubmed PY - 2020/12/23/medline PY - 2019/12/17/entrez KW - cardiovascular disease KW - cognitive function KW - hypertension KW - older adults SP - 496 EP - 504 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 68 IS - 3 N2 - OBJECTIVES: To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function. DESIGN: Secondary analysis. SETTING: Systolic Blood Pressure Intervention Trial (SPRINT) PARTICIPANTS: Adults 80 years or older. INTERVENTION: Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment). MEASUREMENTS: We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4-m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function. RESULTS: Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49-.90), mortality (HR = .67; 95% CI = .48-.93), and MCI (HR = .70; 95% CI = .51-.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28-.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87-2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between-group differences in the rate of injurious falls. CONCLUSION: In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01206062. J Am Geriatr Soc 68:496-504, 2020. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/31840813/Intensive_vs_Standard_Blood_Pressure_Control_in_Adults_80_Years_or_Older:_A_Secondary_Analysis_of_the_Systolic_Blood_Pressure_Intervention_Trial_ DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓31 ↑36]

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