Benefits and risks of more intensive<i> versus</i> less intensive blood pressure control in elderly Asian patients over 60 years old: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

SUN Yang ¹ , LI Bin ² , PENG Guangcao ³ ,  ZHU Mingjun ³

1. Henan University of Chinese Medicine, Zhengzhou 450000, P. R. China;
2. Henan Evidence-based Medicine Center of Chinese Medicine, Zhengzhou 450000, P. R. China;
3. Department of Cardiovascular Diseases, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, P. R. China;

Corresponding?author：

ZHU Mingjun, Email: zhumingjun@163.com

Keywords：

Intensive blood pressure control; Elderly patients; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.202208120

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the benefits and risks of more intensive versus less intensive blood pressure control in Asian elderly patients over 60 years old. Methods The PubMed, EMbase, Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of intensive versus less blood pressure control from inception to August 2022. Two reviewers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 6 RCTs involving 20 701 patients were included. The results of meta-analysis showed that intensive blood pressure control could reduce the incidence of cardiovascular death, stroke, and heart failure. However, it could not reduce the incidence of all-cause death and myocardial infarction. Subgroup analysis showed that systolic blood pressure greater than 140 mmHg could not reduce the incidence of cardiovascular death. The safety evaluation found no increase in adverse events or renal injury in intensive blood pressure control group. Conclusion The current evidence shows that intensive blood pressure control can reduce the incidence of cardiovascular death, stroke and heart failure events in elderly Asian patients over 60 years old, but it has no effect on all-cause mortality and myocardial infarction events. It has good safety. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： SUN Yang, LI Bin, PENG Guangcao, ZHU Mingjun. Benefits and risks of more intensive versus less intensive blood pressure control in elderly Asian patients over 60 years old: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(2): 147-152. doi: 10.7507/1672-2531.202208120 Copy

1.	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
2.	中國心血管健康與疾病報告編寫組. 中國心血管健康與疾病報告2021概要. 中國循環雜志, 2022, 37(6): 553-578.
3.	Sierra C. Hypertension in older adults. Hipertens Riesgo Vasc, 2017, 34(Suppl 2): 26-29.
4.	楊凌鶴, 劉美岑, 陳新月, 等. 高血壓患者的國家基本公共衛生服務自評受益率與服務滿意度調查. 中國全科醫學, 2022, 25(25): 3130-3134, 3142.
5.	馬娟. 高血壓管理及應用新進展. 中華高血壓雜志, 2022, 30(7): 622-627.
6.	Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 2018, 71(6): e13-e115.
7.	Qaseem A, Wilt TJ, Rich R, et al. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med, 2017, 166(6): 430-437.
8.	Unger T, Borghi C, Charchar F, et al. 2020 international society of hypertension global hypertension practice guidelines. Hypertension, 2020, 75(6): 1334-1357.
9.	Takami Y, Yamamoto K, Arima H, et al. Target blood pressure level for the treatment of elderly hypertensive patients: a systematic review and meta-analysis of randomized trials. Hypertens Res, 2019, 42(5): 660-668.
10.	Reboldi G, Angeli F, Gentile G, et al. Benefits of more intensive versus less intensive blood pressure control. Updated trial sequential analysis. Eur J Intern Med, 2022, 101: 49-55.
11.	Zhang Y, Liang M, Sun C, et al. Effect of intensive lowering of systolic blood pressure treatment on heart failure events: a meta-analysis of randomized controlled studies. J Hum Hypertens, 2019, 33(9): 648-657.
12.	Blood Pressure Lowering Treatment Trialists' Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet, 2021, 398(10305): 1053-1064.
13.	Frey L, Gravestock I, Pichierri G, et al. Serious adverse events in patients with target-oriented blood pressure management: a systematic review. J Hypertens, 2019, 37(11): 2135-2144.
14.	陳曉平, 崔兆強, 林金秀, 等. 《2020國際高血壓學會全球高血壓實踐指南》解讀. 中國醫學前沿雜志(電子版), 2020, 12(5): 54-60.
15.	Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, (10): ED000142.
16.	Zhang W, Zhang S, Deng Y, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med, 2021, 385(14): 1268-1279.
17.	Wei Y, Jin Z, Shen G, et al. Effects of intensive antihypertensive treatment on Chinese hypertensive patients older than 70 years. J Clin Hypertens (Greenwich), 2013, 15(6): 420-427.
18.	Gong L, Zhang W, Zhu Y, et al. Shanghai trial of nifedipine in the elderly (STONE). J Hypertens, 1996, 14(10): 1237-1245.
19.	Liu L, Wang JG, Gong L, et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens, 1998, 16(12 Pt 1): 1823-1829.
20.	JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res, 2008, 31(12): 2115-2127.
21.	Ogihara T, Saruta T, Rakugi H, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study. Hypertension, 2010, 56(2): 196-202.
22.	王曉艷. 人種間體質差異對中醫療法的影響. 遼寧中醫藥大學學報, 2009, 11(1): 21-24.
23.	Ali MT, Al Suwaidi J. Racial and ethnic differences in cardiovascular disease and outcome in type 1 diabetes patients. Expert Rev Endocrinol Metab, 2019, 14(4): 225-231.
24.	Chalmers J. Is a blood pressure target of <130/80 mm Hg still appropriate for high-risk patients. Circulation, 2011, 124(16): 1700-1702.
25.	Cruickshank JM, Thorp JM, Zacharias FJ. Benefits and potential harm of lowering high blood pressure. Lancet, 1987, 1(8533): 581-584.
26.	Messerli FH, Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous. Ann Intern Med, 2006, 144(12): 884-893.

1. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
2. 中國心血管健康與疾病報告編寫組. 中國心血管健康與疾病報告2021概要. 中國循環雜志, 2022, 37(6): 553-578.
3. Sierra C. Hypertension in older adults. Hipertens Riesgo Vasc, 2017, 34(Suppl 2): 26-29.
4. 楊凌鶴, 劉美岑, 陳新月, 等. 高血壓患者的國家基本公共衛生服務自評受益率與服務滿意度調查. 中國全科醫學, 2022, 25(25): 3130-3134, 3142.
5. 馬娟. 高血壓管理及應用新進展. 中華高血壓雜志, 2022, 30(7): 622-627.
6. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 2018, 71(6): e13-e115.
7. Qaseem A, Wilt TJ, Rich R, et al. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med, 2017, 166(6): 430-437.
8. Unger T, Borghi C, Charchar F, et al. 2020 international society of hypertension global hypertension practice guidelines. Hypertension, 2020, 75(6): 1334-1357.
9. Takami Y, Yamamoto K, Arima H, et al. Target blood pressure level for the treatment of elderly hypertensive patients: a systematic review and meta-analysis of randomized trials. Hypertens Res, 2019, 42(5): 660-668.
10. Reboldi G, Angeli F, Gentile G, et al. Benefits of more intensive versus less intensive blood pressure control. Updated trial sequential analysis. Eur J Intern Med, 2022, 101: 49-55.
11. Zhang Y, Liang M, Sun C, et al. Effect of intensive lowering of systolic blood pressure treatment on heart failure events: a meta-analysis of randomized controlled studies. J Hum Hypertens, 2019, 33(9): 648-657.
12. Blood Pressure Lowering Treatment Trialists' Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet, 2021, 398(10305): 1053-1064.
13. Frey L, Gravestock I, Pichierri G, et al. Serious adverse events in patients with target-oriented blood pressure management: a systematic review. J Hypertens, 2019, 37(11): 2135-2144.
14. 陳曉平, 崔兆強, 林金秀, 等. 《2020國際高血壓學會全球高血壓實踐指南》解讀. 中國醫學前沿雜志(電子版), 2020, 12(5): 54-60.
15. Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, (10): ED000142.
16. Zhang W, Zhang S, Deng Y, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med, 2021, 385(14): 1268-1279.
17. Wei Y, Jin Z, Shen G, et al. Effects of intensive antihypertensive treatment on Chinese hypertensive patients older than 70 years. J Clin Hypertens (Greenwich), 2013, 15(6): 420-427.
18. Gong L, Zhang W, Zhu Y, et al. Shanghai trial of nifedipine in the elderly (STONE). J Hypertens, 1996, 14(10): 1237-1245.
19. Liu L, Wang JG, Gong L, et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens, 1998, 16(12 Pt 1): 1823-1829.
20. JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res, 2008, 31(12): 2115-2127.
21. Ogihara T, Saruta T, Rakugi H, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study. Hypertension, 2010, 56(2): 196-202.
22. 王曉艷. 人種間體質差異對中醫療法的影響. 遼寧中醫藥大學學報, 2009, 11(1): 21-24.
23. Ali MT, Al Suwaidi J. Racial and ethnic differences in cardiovascular disease and outcome in type 1 diabetes patients. Expert Rev Endocrinol Metab, 2019, 14(4): 225-231.
24. Chalmers J. Is a blood pressure target of <130/80 mm Hg still appropriate for high-risk patients. Circulation, 2011, 124(16): 1700-1702.
25. Cruickshank JM, Thorp JM, Zacharias FJ. Benefits and potential harm of lowering high blood pressure. Lancet, 1987, 1(8533): 581-584.
26. Messerli FH, Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous. Ann Intern Med, 2006, 144(12): 884-893.

Chinese Journal of Evidence-Based Medicine

Benefits and risks of more intensive versus less intensive blood pressure control in elderly Asian patients over 60 years old: a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content