Prior to November 2015, the discussion of hypertension treatment in the elderly focused on the risks of polypharmacy and lack of evidence that aggressive treatment was beneficial. That all changed with the publication of the Systolic Blood Pressure Intervention Trial (SPRINT, which researchers ended early when they discovered that targeting a systolic blood pressure (BP) of 120 mmHg conferred a benefit on cardiovascular morbidity and mortality in adults ≥ 50 years of age with hypertension but no history of type 2 diabetes mellitus or stroke. This finding even applied to those ≥ 75 years of age. Still, concerns linger that aggressive BP management might affect mobility in those > 75 years of age. However, a new study from the SPRINT group examined this issue. The results are reassuring. Some 2,600 men (40%) and women (60%) ≥ 75 years of age were followed for three years. Researchers randomized half the group to standard treatment (target systolic BP < 140 mmHg) and the other half to intensive treatment (target systolic BP < 120 mmHg). Researchers measured gait speed using the 4-meter walk test and measured mobility limitation on several self-reported health surveys. The investigators noted no difference in mean gait speed between the two treatment groups (95% confidence interval [CI], -0.005 to 0.005; P = 0.88), and there was no reported mobility limitation (hazard ratio [HR], 1.06; 95% CI, 0.92-1.22). (JAMA Intern Med. Published online Feb. 6, 2017. doi: 10.1001/jamainternmed.2016.9104)
SPRINT continues to stimulate conversation and controversy. Even with new data, not all hypertension experts have signed off on newer, aggressive BP targets. In an editorial published in JAMA, Aram V. Chobanian, MD, dean of the Boston University School of Medicine and lead author of the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, argued that setting BP goals is not an exact science. He recommended general systolic BP targets of < 120/80 mmHg in patients < 50 years of age but raises the target to 130 mmHg for those 50-74 years of age and < 140 mmHg in those > 75 years of age. He also recommended a holistic approach that incorporates statins and smoking cessation for appropriate patients. (JAMA 2017;317:579-580)
Concerns linger that aggressive BP management might affect mobility in those > 75 years of age.
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