Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Dec 5;17(1):279.
doi: 10.1186/s12877-017-0672-4.

Achieved systolic blood pressure in older people: a systematic review and meta-analysis

Aline A I Moraes  1 , Cristina P Baena  2 , Taulant Muka  3 , Arjola Bano  3 , Adriana Buitrago-Lopez  4 , Ana Zazula  5 , Bruna O Erbano  6 , Nicolle A Schio  5 , Murilo H Guedes  5 , Wichor M Bramer  7 , Oscar H Franco  3 , José Rocha Faria-Neto  2
Affiliations
Meta-Analysis

Achieved systolic blood pressure in older people: a systematic review and meta-analysis

Aline A I Moraes et al. BMC Geriatr. .

Abstract

Background: It remains unclear into which level the systolic blood pressure (SBP) should be lowered in order to provide the best cardiovascular protection among older people. Hypertension guidelines recommendation on attaining SBP levels <150 mmHg in this population is currently based on experts' opinion. To clarify this issue, we systematically reviewed and quantified available evidence on the impact of achieving different SBP levels <150 mmHg on various adverse outcomes in subjects aged ≥60 years old receiving antihypertensive drug treatment.

Methods: We searched 8 databases to identify randomized controlled trials (RCTs) and post-hoc analyses or subanalyses of RCTs reporting the effects of attaining different SBP levels <150 mmHg on the risk of stroke, acute myocardial infarction, heart failure, cardiovascular mortality and all-cause mortality in participants aged ≥60 years. We performed random-effects meta-analyses stratified by study design.

Results: Eleven studies (> 33,600 participants) were included. Compared with attaining SBP levels ≥140 mmHg, levels of 130 to <140 mmHg were not associated with lower risk of outcomes in the meta-analysis of RCTs, whereas there was an associated reduction of cardiovascular mortality (RR 0.72, 95% CI 0.59-0.88) and all-cause mortality (RR 0.86, 95% CI 0.75-0.99) in the meta-analysis of post-hoc analyses or subanalyses of RCTs. Limited and conflicting data were available for the SBP levels of <130 mmHg and 140 to <150 mmHg.

Conclusions: Among older people, there is suggestive evidence that achieving SBP levels of 130 to <140 mmHg is associated with lower risks of cardiovascular and all-cause mortality. Future trials are required to confirm these findings and to provide additional evidence regarding the <130 and 140 to <150 mmHg SBP levels.

Keywords: Aged; Antihypertensive agents; Antihypertensive drugs; Antihypertensives; Blood pressure; Hypertension; Older people.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable, since data for this systematic review and meta-analysis was collected from published studies.

Consent for publication

Not applicable, since data for this systematic review and meta-analysis was collected from published studies.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram for study selection
Fig. 2
Fig. 2
Cardiovascular outcomes and all-cause mortality for SBP 130 to <140 versus ≥ 140 mmHg. Panel a: stroke; Panel b: acute myocardial infarction; Panel c: cardiovascular mortality; Panel d: All-cause mortality. Results are stratified by study design. The size of the marker represents the weight of each trial. Weighted average of blood pressure is described for each outcome. SBP, systolic blood pressure; RR, relative risk; 95% CI, 95% confidence interval; RCTs, randomized controlled trials; D + L, DerSimonian-Laird random effect model
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2224–2260. doi: 10.1016/S0140-6736(12)61766-8. - DOI - PMC - PubMed
    1. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–952. doi: 10.1016/S0140-6736(04)17018-9. - DOI - PubMed
    1. O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376:112–123. doi: 10.1016/S0140-6736(10)60834-3. - DOI - PubMed
    1. Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation task force on clinical expert consensus documents. Circulation. 2011;123:2434–2506. doi: 10.1161/CIR.0b013e31821daaf6. - DOI - PubMed
    1. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. New Engl J Med. 2008;358:1887–1898. doi: 10.1056/NEJMoa0801369. - DOI - PubMed

MeSH terms

Substances