Effects of Intensive Antihypertensive Treatment on Chinese Hypertensive Patients Older Than 70 Years

Abstract

2This study was performed to investigate whether intensive antihypertensive treatment with achieved blood pressure (BP) 140/90 mm Hg, as compared with standard treatment with achieved BP 150/90 mm Hg, could further improve cardiovascular outcomes in Chinese hypertensive patients older than 70 years. A total of 724 participants were randomly assigned to intensive or standard antihypertensive treatment. After a mean follow-up of 4 years, the mean achieved BP was 135.7/76.2 mm Hg in the intensive treatment group and 149.7/82.1 mm Hg in the standard treatment group. The visit-to-visit variability in systolic BP and diastolic BP was lower in the intensive group than that in the standard group. Intensive antihypertensive treatment, compared with the standard treatment, decreased total and cardiovascular mortality by 41.7% and 50.3%, respectively, and reduced fatal/nonfatal stroke by 42.0% and heart failure death by 62.7%. Cox regression analysis indicated that the mean systolic BP (P=.020; 95% confidence interval, 1.006-1.069) and the standard deviation of systolic BP (P=.033; 95% confidence interval, 1.006-1.151) were risk factors for cardiovascular endpoint events. Intensive antihypertensive treatment with achieved 136/76 mm Hg was beneficial for Chinese hypertensive patients older than 70 years. Longterm visit-to-visit variability in systolic BP was positively associated with the incidence of cardiovascular events. J Clin Hypertens (Greenwich). 2013;15:420-427. ª2013 Wiley Periodicals, Inc.Hypertension is one of the most common diseases associated with the elderly. It is a significant risk factor for senile congestive heart failure, stroke, coronary heart disease, renal failure, and aortic aneurysm and has become an important public-health challenge worldwide.1 The risks associated with hypertension are greater in older than in younger patients, and antihypertensive treatment is reported to be actually more cost-effective for the elderly.2 The results of the study for the Hypertension in the Very Elderly Trial (HYVET) suggest that antihypertensive treatment with the achieved blood pressure (BP) of 143.5/77.9 mm Hg was beneficial in hypertensive patients older than 80 years, associated with a 30% reduction in the rate of fatal or nonfatal stroke, a 39% reduction in the rate of death from stroke, a 21% reduction in the rate of death from any cause, a 23% reduction in the rate of death from cardiovascular causes, and a 64% reduction in the rate of heart failure, compared with the placebo group with the achieved BP of 158.5/84.0 mm Hg.3 Thus, BP reduction in preventing stroke and other cardiovascular events for elderly hypertensive patients has evoked great focus in the past decade. Although many guidelines for the management of hypertension proposed the goal of systolic BP (SBP) as <150 mm Hg for the elderly, 4,5 it is unclear whether further reduction is still beneficial. In addition, although it has been suggested that BP variability derived from 24-hour ambulatory monitoring may be an independent risk factor for ...

Risk Factor of Cardiovascular Disease Among Older Individuals

“…Furthermore, it was reported in this issue of the Journal of Atherosclerosis and Thrombosis that hypertension was the only risk factor significantly associated with stroke incidence in individuals aged ≥ 75 years (old-old) and 60–74 years (young-old) in the Ohasama Study 7) . These results from the observational studies 8–16) together with findings of previous intervention studies 17–20) confirm the appropriateness of the current hypertension guidelines for the management of hypertension for older individuals in Japan 21) ( Table 1 ).…”

Hypertension and Related Cardiovascular Disease Burden in China

“…31 Wei and colleagues recently showed that treatment to an SBP target of <140 mm Hg using a variety of medications decreased total and cardiovascular mortality by 41.7% and 50.4%, respectively, in a population of Chinese patients >70 years. 32 Other recent results reported by the China Stroke Primary Prevention Trial suggest that addition of folic acid to antihypertensive treatment may afford further reduction in risk for stroke. 33 Clinical trials have shown clear benefits to any antihypertensive treatment.…”

Benefits and risks of antihypertensive medications in the elderly

“…There were no significant differences in CV events between the treatment groups in subgroup analyses of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) [26], the Combination therapy of hypertension to Prevent cardiovascular Events (COPE) [27] and Intervention as a Goal in Hypertension (INSIGHT) [28] and Valsartan Antihypertensive Long-term Use Evaluation (VALUE) [29], as well as in the Japanese Trial to Assess Optimal Systolic blood pressure (JATOS) [30], SCOPE [21], STOP-H2 [31] and Valsartan in elderly Isolated Systolic Hypertension (VALISH) studies [32] as a main outcome of these trials. In addition, a significant reduction in heart failure was demonstrated in subgroup analyses of the ALLHAT [33], SHEP [34] and VALUE [29] studies, and as a secondary outcome in PROBE [20]. However, there was a significant increase in heart failure in those assigned to doxazosin compared to the chlorthalidone group in ALLHAT [23].…”

“…At least five RCTs have demonstrated that antihypertensive drugs decrease all-cause mortality in hypertensive elderly patients. The reduction in allcause mortality was a primary outcome in the trial by Wing et al [25] and a secondary outcome in the HYVET [5], PROBE [20], STOP-H [17] and INSIGHT [28] studies. By contrast, the results of other trials have indicated no significant difference in all-cause mortality amongst treatment groups in the elderly [14,16,18,19,21,23,35].…”