Blood Pressure Targets in Elderly Hypertensive Patients: SPRINT Revisited

Abstract

Introduction: Optimal systolic blood pressure (SBP) target in patients ≥75 years remains uncertain, balancing cardiovascular benefit against adverse events like hypotension and acute kidney injury (AKI). Methods: Systematic review and meta-analysis of 6 RCTs (n=15,432) comparing intensive (SBP <130 mmHg) versus standard (SBP <140-150 mmHg) targets in patients ≥75 years. Primary composite outcome: myocardial infarction, stroke, heart failure, cardiovascular death. Results: Intensive control reduced primary outcome (11.2% vs 14.8%, HR 0.72, 95% CI 0.61-0.85). However, rates of serious hypotension (4.5% vs 1.9%, p<0.001) and AKI (5.1% vs 2.8%, p<0.001) were higher. No difference in falls or fracture rates. Number needed to treat (NNT) for one cardiovascular event prevented was 28; number needed to harm (NNH) for AKI was 44. Discussion: Intensive targets provide net benefit in fit elderly but require close monitoring. Frail patients or those with orthostatic hypotension may not benefit. Conclusion: Target SBP <130 mmHg is reasonable for community-dwelling elderly without frailty or polypharmacy. Individualization remains essential.