Pharmacological BP reduction effective for lowering CV event risk regardless of age
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Lowering BP through medication reduced risk for CV events across almost all age groups, suggesting age-related BP thresholds should be removed from guidelines, researchers reported at the European Society of Cardiology Congress.
The reductions were consistent regardless of baseline systolic BP.
The researchers conducted a meta-analysis of 358,707 participants from 51 randomized trials. The median age was 69 years, with 12% younger than 55 years (35% women), 35.8% aged 55 to 64 years (39% women), 35.8% aged 65 to 74 years (42% women), 15.1% aged 75 to 84 years (52% women) and 1.3% aged 85 years or older (61% women).
“It has been known for quite some time that in older people who have substantially elevated blood pressure, pharmacological blood pressure reduction will prevent cardiovascular events,” Kazem Rahimi, FRCP, DM, MSc, FESC, professor of cardiovascular medicine and population health at the University of Oxford, U.K., said during a presentation. “However, randomized evidence on the effects of treatment in older people when their blood pressure is not substantially elevated has been limited. This has led to conflicting guideline recommendations and variability in care across the world.”
The primary outcome was fatal or nonfatal stroke, fatal or nonfatal MI or ischemic heart disease or HF causing death or hospitalization. The results were simultaneously published in The Lancet.
For each 5 mm Hg reduction in systolic BP, the risk for the primary outcome was lowered by 18% in participants younger than 55 years (HR = 0.82; 95% CI, 0.76-0.88), 9% in those aged 55 to 64 years (HR = 0.91; 95% CI, 0.88-0.95), 9% in those aged 65 to 74 years (HR = 0.91; 95% CI, 0.88-0.95), 9% in those aged 75 to 84 years (HR = 0.91; 95% CI, 0.87-0.96) and 1% in those aged 85 years or older (HR = 0.99; 95% CI, 0.87-1.12; adjusted P for interaction = .05), according to the researchers.
The absolute risk reductions for major CV events were larger in older age groups (adjusted P for interaction = .024), according to the researchers.
The RR reductions “had a bit of a diminishing effect in the older groups; however, if one looks at the absolute risk difference, a reverse pattern seems to be evident, where if anything, the absolute risk differences increase at an increasing age, largely reflective of an increase in risk of major cardiovascular events in the older populations,” Rahimi said during the presentation.
Rahimi and colleagues found similar primary outcome reductions across age for each 3 mm Hg lowering of diastolic BP.
The results did not vary by baseline BP, Rahimi said.
“This large-scale analysis of randomized evidence shows that pharmacological blood pressure reduction is effective into old age, with no evidence to suggest that relative risk reductions for major cardiovascular events vary by systolic or diastolic blood pressure at the time of randomization, down to a level of less than 120/70 mm Hg,” Rahimi said. “The implication of this study is that pharmacological blood pressure reduction should be considered as an important treatment option regardless of age, with removal of age-related thresholds from international guidelines.”
Reference:
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Rahimi K, et al. Latest Science in Hypertension. Presented at: European Society of Cardiology Congress; Aug. 27-30, 2021 (virtual meeting).
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