Intensive Blood Pressure Control Lowers Cardiovascular Risk | Cardiology | JAMA | JAMA Network
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Clinical Trials Update
November 23/30, 2021

Intensive Blood Pressure Control Lowers Cardiovascular Risk

JAMA. 2021;326(20):2001. doi:10.1001/jama.2021.20472

Older patients with hypertension had fewer cardiovascular events when they received intensive treatment targeting a lower systolic blood pressure target in the STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) trial.

The study, conducted in China, randomly assigned 8511 patients aged 60 to 80 years to an intensive systolic blood pressure target of 110 mm Hg to less than 130 mm Hg or a standard target of 130 mm Hg to less than 150 mm Hg. The primary outcome was a composite of stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes.

The trial was stopped early due to a clear cardiovascular benefit in the intensive-treatment group. During a median follow-up of more than 3 years, cardiovascular events occurred in 3.5% of that group compared with 4.6% of the standard-treatment group. Safety and kidney outcomes also were similar between groups, with the exception of hypotension, which was higher in the intensive-treatment group.

Writing in the New England Journal of Medicine, the authors advised caution in extrapolating the results to populations not studied in the trial, including patients with a history of stroke.