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ESP Report: Benefits and Harms of Treating Blood Pressure in Older Adults: A Systematic Review and Meta-analysis

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Benefits and Harms of Treating Blood Pressure in Older Adults: A Systematic Review and Meta-analysis

Principal Investigators: Jessica Weiss, MD; Devan Kansagara, MD, MCR
Co-Investigators: Amy Kerfoot, MD; Michele Freeman, MPH; Makalapua Motu'apuaka, BS; Rochelle Fu, PhD; Allison Low, BA; Robin Paynter, MLIS; Karli Kondo, PhD

Evidence-based Synthesis Program (ESP) Center, Portland VA Health Care System, Portland, OR

Washington (DC): Department of Veterans Affairs; April 2016


Download PDF: Complete Report, Executive Summary, Report, Appendices

Introduction

Hypertension is a very common chronic illness in the United States and among Veterans. Use of antihypertensive medications can lower the risk of cardiovascular disease, cerebrovascular disease, renal disease, and death. The most beneficial blood pressure targets for patients of specific age groups, however, has been a topic of some debate and controversy, stemming from concerns that the ratio of benefit to harm of a given blood pressure level may vary with age. In 2014, the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (previously JNC-FG8, referred to in this report as JNC-BP) published new guidelines for the treatment of hypertension, as well as a new treatment goal for older individuals (over age 60) for systolic blood pressure (SBP) of < 150 mm Hg rather than < 140 mm Hg. The new goal for those over 60 years of age has been very controversial; the issue of the appropriate (safest and most beneficial) goal for older people has been debated among experts with viewpoints supporting both higher and lower treatment goals. The objectives of this review are to examine the benefits and harms of differing blood pressure targets among adults over age 60.

Key Question 1. In adults aged over age 60, what are the health outcome effects of differing blood pressure targets?

Key Question 1b. In patients who have suffered a transient ischemic attack (TIA) or stroke, does treatment of blood pressure to specific targets affect outcomes?

Key Question 2: How does age modify the benefits of differing blood pressure targets?

Key Question 3: How does the patient burden of comorbidities modify the benefits of differing blood pressure targets?

Key Question 4. What are the harms of targeting lower blood pressure in older patients? Do the harms vary with age?

Key Question 5. Do the harms of targeting lower blood pressure vary with patient burden of comorbidities?


See also

On April 18, 2017 the ACP Journal Club featured the ACP/AAFP hypertension guidelines based on this report.

Benefits and Harms of Treating Blood Pressure in Older Adults (Management Brief)

Benefits and Harms of Treating Blood Pressure in Older Adults: A Systematic Review and Meta-analysis (Cyberseminar)

Weiss J, Freeman M, Low A, et al. Benefits and Harms of Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older: A Systematic Review and Meta-analysis. Annals of Internal Medicine. 2017;166(6):419-429. DOI: 10.7326/M16-1754.