1. Ann Intern Med. 2017 Mar 21;166(6):419-429. doi: 10.7326/M16-1754. Epub 2017 Jan 
17.

Benefits and Harms of Intensive Blood Pressure Treatment in Adults Aged 60 Years 
or Older: A Systematic Review and Meta-analysis.

Weiss J(1), Freeman M(1), Low A(1), Fu R(1), Kerfoot A(1), Paynter R(1),
Motu'apuaka M(1), Kondo K(1), Kansagara D(1).

Author information: 
(1)From Veterans Affairs Portland Health Care System and Oregon Health & Science 
University, Portland, Oregon.

Erratum in
    Ann Intern Med. 2018 Jan 16;168(2):159.

Comment in
    Ann Intern Med. 2017 Aug 15;167(4):288.
    Ann Intern Med. 2017 Aug 15;167(4):288-289.

Background: Recent guidelines recommend a systolic blood pressure (SBP) goal of
less than 150 mm Hg for adults aged 60 years or older, but the balance of
benefits and harms is unclear in light of newer evidence.
Purpose: To systematically review the effects of more versus less intensive BP
control in older adults.
Data Sources: Multiple databases through January 2015 and MEDLINE to September
2016.
Study Selection: 21 randomized, controlled trials comparing BP targets or
treatment intensity, and 3 observational studies that assessed harms.
Data Extraction: Two investigators extracted data, assessed study quality, and
graded the evidence using published criteria.
Data Synthesis: Nine trials provided high-strength evidence that BP control to
less than 150/90 mm Hg reduces mortality (relative risk [RR], 0.90 [95% CI, 0.83 
to 0.98]), cardiac events (RR, 0.77 [CI, 0.68 to 0.89]), and stroke (RR, 0.74
[CI, 0.65 to 0.84]). Six trials yielded low- to moderate-strength evidence that
lower targets (≤140/85 mm Hg) are associated with marginally significant
decreases in cardiac events (RR, 0.82 [CI, 0.64 to 1.00]) and stroke (RR, 0.79
[CI, 0.59 to 0.99]) and nonsignificantly fewer deaths (RR, 0.86 [CI, 0.69 to
1.06]). Low- to moderate-strength evidence showed that lower BP targets do not
increase falls or cognitive impairment.
Limitation: Data relevant to frail elderly adults and the effect of
multimorbidity are limited.
Conclusion: Treatment to at least current guideline standards for BP (<150/90 mm 
Hg) substantially improves health outcomes in older adults. There is less
consistent evidence, largely from 1 trial targeting SBP less than 120 mm Hg, that
lower BP targets are beneficial for high-risk patients. Lower BP targets did not 
increase falls or cognitive decline but are associated with hypotension, syncope,
and greater medication burden.
Primary Funding Source: U.S. Department of Veterans Affairs, Veterans Health
Administration, Office of Research and Development, Quality Enhancement Research 
Initiative. (PROSPERO 2015: CRD42015017677).

DOI: 10.7326/M16-1754 
PMID: 28114673  [Indexed for MEDLINE]