The DOI matches its Crossref record; 13 of the 13 references it cites were found in a registry or an index.
Benefits and Harms of Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older: A Systematic Review and Meta-analysis
Abstract
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).
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Brenner, B. M., Cooper, M. E., de Zeeuw, D., Keane, W. F., Mitch, W. E., Parving, H.-H., Remuzzi, G., Snapinn, S. M., Zhang, Z., & Shahinfar, S. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa011161 · Cited by 7,493
A Randomized Trial of Intensive versus Standard Blood-Pressure Control
The SPRINT Research Group (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1511939 · Cited by 6,325
Hansson, L., Zanchetti, A., Carruthers, S. G., Dahlöf, B., Elmfeldt, D., Julius, S., Ménard, J., Rahn, K. H., Wedel, H., & Westerling, S. (1998) · The Lancet · doi:10.1016/s0140-6736(98)04311-6 · Cited by 5,728
Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J., Chalmers, J., Rodgers, A., & Rahimi, K. (2016) · The Lancet · doi:10.1016/s0140-6736(15)01225-8 · Cited by 3,755 · cited 1×
“A more recent meta-analysis found that treatment with antihypertensive medication improved outcomes down to an SBP less than 130 mm Hg and effects did not differ on the basis of cardiovascular risk, but it included a broad array of studies, including studies of normotensive patients (56).”
BackgroundEffects of intensive blood-pressure control in type 2 diabetes mellitus
(2010) · New England Journal of Medicine · doi:10.1056/nejmoa1001286 · Cited by 3,598
Treatment of hypertension in patients 80 years of age or older
Beckett, N. S., Peters, R., Fletcher, A. E., Staessen, J. A., Liu, L., Dumitrascu, D., Stoyanovsky, V., Antikainen, R. L., Nikitin, Y., Anderson, C., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0801369 · Cited by 3,092
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Forette, F. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.18.2046 · Cited by 898
Blood Pressure Lowering in Type 2 Diabetes: A Systematic Review and Meta-analysis
Emdin, C. A., Rahimi, K., Neal, B., Callender, T., Perkovic, V., & Patel, A. (2015) · JAMA · doi:10.1001/jama.2014.18574 · Cited by 854
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Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000065 · Cited by 7,391
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Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000950 · Cited by 5,784
Metadata
- Authors
- Weiss, J., Freeman, M., Low, A., Fu, R., Kerfoot, A., Paynter, R., Motu'apuaka, M., Kondo, K., & Kansagara, D.
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2017-03-21
- Volume
- 166
- Issue
- 6
- Pages
- 419-429
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2582957325
- Cited by
- 166
- References
- 13
- FWCI
- 18.12
- Type
- journal article
- Language
- en
- Open access
- closed
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- The paper
- Weiss, J., Freeman, M., Low, A., Fu, R., Kerfoot, A., Paynter, R., Motu'apuaka, M., Kondo, K., & Kansagara, D. (2017). 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. https://doi.org/10.7326/m16-1754
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
