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
Randomized Controlled Trial
. 2022 Sep;37(5):1070-1081.
doi: 10.3904/kjim.2022.067. Epub 2022 Jul 21.

Optimal blood pressure target in the elderly: rationale and design of the HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial

Dong-Hwa Lee  1 , Ju-Hee Lee  1   2 , So Young Kim  2 , Hae-Young Lee  3   4 , Jung-Yeon Choi  5 , Youjin Hong  6   7 , Sue K Park  6   7   8 , Dong Ryeol Ryu  9 , Dong Heon Yang  10 , Seok-Jae Hwang  11 , Jung Hyun Choi  12 , Kye Hun Kim  13 , Sun Hwa Lee  14 , Seung Jae Joo  15 , Jae-Hyeong Park  16 , Sang-Hyun Kim  3   17 , Hack-Lyong Kim  3   17 , Kwang-Il Kim  3   5 , Myeong-Chan Cho  1   2
Affiliations
Randomized Controlled Trial

Optimal blood pressure target in the elderly: rationale and design of the HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial

Dong-Hwa Lee et al. Korean J Intern Med. 2022 Sep.

Abstract

Background/aims: The optimal systolic blood pressure (SBP) goal for elderly patients with hypertension, especially to reduce cardiovascular disease (CVD) incidence and improve outcome, is unclear. This study aimed to evaluate the beneficial effects of intensive treatment for hypertension on the incidence of CVD in elderly Korean patients.

Methods: The HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial is a multicenter, parallel-design, open-label, randomized controlled trial designed to evaluate whether intensive treatment (SBP ≤ 130 mmHg) will provide more benefits in lowering the incidence and mortality associated with CVD than standard treatment (SBP ≤ 140 mmHg) in elderly patients with hypertension aged ≥ 65 years. For this study, eleven university hospitals in Korea will enroll approximately 3,176 elderly patients with hypertension between 2019 and 2022. Patients will be requested to visit the clinic every 4 months for the first year and every 6 months thereafter for 36 months. Parameters, including clinic and home blood pressure, anthropometric and laboratory findings, and frailty assessments, will be collected according to the standardized protocol. The primary outcome is a composite of CVD (acute coronary syndrome, stroke, and heart failure) incidence and cardiovascular deaths.

Results: As of December 2021, 1,655 participants had been enrolled in the study, including 831 patients in the standard group and 824 patients in the intensive group.

Conclusion: The HOWOLD-BP trial is the first study performed in Korea to evaluate the beneficial effects of intensive blood pressure treatment on CVD in elderly patients with hypertension. The results of this study will help clarify the appropriate target SBP for this population.

Keywords: Aged; Blood pressure; Goals; Hypertension; Randomized controlled trial.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Diagram of the HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial. SBP, systolic blood pressure; CV, cardiovascular.
None
See this image and copyright information in PMC

References

    1. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, Comparative Risk Assessment Collaborating Group Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347–1360. - PubMed
    1. Kannel WB. Historic perspectives on the relative contributions of diastolic and systolic blood pressure elevation to cardiovascular risk profile. Am Heart J. 1999;138(3 Pt 2):205–210. - PubMed
    1. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data Brief. 2020;364:1–8. - PubMed
    1. Kim HC, Cho SM, Lee H, et al. Korea hypertension fact sheet 2020: analysis of nationwide population-based data. Clin Hypertens. 2021;27:8. - PMC - PubMed
    1. Staessen JA, Wang JG, Thijs L. Cardiovascular protection and blood pressure reduction: a meta-analysis. Lancet. 2001;358:1305–1315. - PubMed

Publication types

Substances