Does Intensive Systolic Blood Pressure (SBP) Control Reduce Cardiovascular Mortality in U.S. Adults Aged 80+?
Does Intensive Systolic Blood Pressure (SBP) Control Reduce Cardiovascular Mortality in U.S. Adults Aged 80+?
Source: Yang H, Huang C, Sawano M, et al. JACC, Published online March 17, 2025
DOI: 10.1016/j.jacc.2025.01.033
1. Background
• Current BP guidelines support intensive SBP control but lack specific evidence for individuals aged 80 years and older.
• This study evaluated the association between SBP levels and cardiovascular mortality in U.S. adults aged 80+ on antihypertensive therapy.
2. Methods
• Data from 1,593 adults aged 80+ (1988–2014) from NHANES, linked to the National Death Index (follow-up through 2019).
• SBP categorized into 3 groups:
• <130 mmHg
• 130–160 mmHg (reference group, based on ACC/AHA and ESC guidelines)
• >160 mmHg
• SBP was measured according to standard protocols; the mean of the 2nd and 3rd readings was used.
• Primary outcome: Cardiovascular disease (CVD) mortality.
• Mean follow-up: 6.7 year.
3. Key Findings
• Total 1,295 deaths during follow-up; 596 (46%) were from cardiovascular causes.
• Lower SBP (<130 mmHg) was associated with a reduced risk of cardiovascular death:
• Adjusted Hazard Ratio (HR) for SBP <130 mmHg vs. 130–160 mmHg: 0.74
• Higher SBP (>145 mmHg) was associated with increased cardiovascular mortality risk.
• Findings were consistent despite the population being aged 80+, a group often underrepresented in trials.
4. Conclusions
• Intensive SBP control (<130 mmHg) is associated with lower cardiovascular mortality in U.S. adults aged 80+ on antihypertensive treatment.
• These results support current guidelines promoting lower SBP targets, even in older populations.
