The participants were randomized to either an intensive treatment goal of systolic pressure less than 120 mm Hg or a standard treatment goal of less than 140 mm Hg. The objective was to see if intensive blood pressure treatment reduced the incidence of adverse cardiovascular outcomes compared with standard control. They had few comorbidities, and patients with diabetes mellitus or prior stroke were excluded. The Systolic Blood Pressure Intervention Trial (SPRINT) 2 enrolled 9,361 patients who, to enter, had to be at least 50 years old (the mean age was 67.9), have a systolic blood pressure of 130 to 180 mm Hg (the mean was 139.7 mm Hg), and be at risk of cardiovascular disease due to chronic kidney disease, clinical or subclinical cardiovascular disease, a 10-year Framingham risk score of at least 15%, or age 75 or older. The goals of treatment should be patient-centered.ĭATA BEHIND THE GUIDELINE: THE SPRINT TRIAL These recommendations apply only to older adults who can walk and are living in the community, not in an institution, and includes the subset of older adults who have mild cognitive impairment and frailty. The recommendation for older adults omits a target diastolic pressure, since treating elevated systolic pressure has more data supporting it than treating elevated diastolic blood pressure in older people. Although risk increases with age, the tools are inaccurate once the patient is approximately 80 years of age.
All tools incorporate major predictors such as age, blood pressure, cholesterol profile, and other markers, depending on the tool. There are multiple tools to estimate the 10-year risk. The target blood pressure for those at lower risk is less than 140/90 mm Hg. 1 This new guideline advocates drug treatment of hypertension to a target less than 130/80 mm Hg for patients of all ages for secondary prevention of cardiovascular disease, and for primary prevention in those at high risk (ie, an estimated 10-year risk of atherosclerotic cardiovascular disease of 10% or higher).
This recommendation is part of the 2017 hypertension guideline from the American College of Cardiology and American Heart Association. We should aim for a standard office systolic pressure lower than 130 mm Hg in most adults age 65 and older if the patient can take multiple antihypertensive medications and be followed closely for adverse effects.
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