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. 2023 Aug 1;30(10):1017-1027.
doi: 10.1093/eurjpc/zwad142.

Achieved systolic blood pressure and cardiovascular outcomes in 60-80-year-old patients: the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial

Yue Deng  1 , Jingjing Bai  1 , Xinchun Yang  2 , Wei Liu  3 , Zihong Guo  4 , Juyan Zhang  5 , Rongjie Huang  6 , Xiaomin Yang  7 , Chunli Yu  8 , Jing Yu  9 , Xiurong Guo  1 , Hailei Wu  1 , Peiyu Liu  1 , Weili Zhang  1 , Jun Cai  1
Affiliations

Achieved systolic blood pressure and cardiovascular outcomes in 60-80-year-old patients: the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial

Yue Deng et al. Eur J Prev Cardiol. .

Abstract

Aims: Intensive systolic blood pressure (SBP) lowering has been increasingly used; however, data is missing on patients who had target-achieved (TA). This study aims to show the cardiovascular effect of maintaining SBP at intensive levels.

Methods: The Strategy of Blood Pressure Intervention in Elderly Hypertensive Patients (STEP) trial was a multicentre, randomized, controlled trial which enrolled 8511 young-older (60-80 years) hypertensive patients without prior stroke to compare the cardiovascular prognosis of the intensive treatment (SBP target, 110 to <130 mmHg) vs. the standard treatment (130 to <150 mmHg). This secondary analysis assessed data in patients who achieved a mean SBP within target values. The association of mean achieved SBP and cardiovascular events was examined using a cubic spline function.

Results: In total, 3053 patients (72.0%) in the intensive-treatment group and 3427 (80.3%) in the standard-treatment group had an SBP target achieved, with mean follow-up SBP values of 124.2 mmHg and 137.4 mmHg, respectively. Throughout the median 3.38-year follow-up, the cardiovascular risk was significantly lower in the TA intensive-treatment group than in the TA standard-treatment group [adjusted hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.46-0.80; P < 0.001]. In the intensive-treatment group, patients failing to achieve SBP targets presented higher cardiovascular risk than those TA patients (HR 2.04, 95% CI 1.44-2.88; P < 0.001). A J-shaped relationship was observed between the mean achieved SBP and risk of cardiovascular events, with the lowest risk at an SBP of 126.9 mmHg.

Conclusions: Maintaining SBP at <130 mmHg offers additional cardiovascular benefits among young-older patients with hypertension.

Registration: ClinicalTrials.gov: NCT03015311.

Keywords: Cardiovascular disease; Hypertension; Per-protocol analysis; Strategy of blood pressure intervention in elderly hypertensive patients; Systolic blood pressure; Young-older patient.

Plain language summary

This present study is a secondary analysis that investigated the association between mean achieved BP in the two treatment groups (SBP target, 110 to <130 vs. 130 to <150 mmHg) and their cardiovascular outcomes in the STEP study (60–80-year-old patients with hypertension).Patients achieving a target in the intensive-treatment group have better cardiovascular outcome than patients achieving a target in the standard treatment arm, supporting the cardiovascular benefits of maintaining SBP <130 mmHg.J-shaped relationships were observed between mean achieved SBP and cardiovascular outcomes (with the nadir around 130 mmHg), but not for stroke.

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Conflict of interest statement

Conflict of interest: Olmesartan medoxomil tablets were donated by Nanjing Chia Tai Tianqing Pharmaceutical Co. Ltd., Nanjing, China. Amlodipine besylate tablets were donated by China Resources Saike Pharmaceutical Co. Ltd., Beijing, China. BP monitors were donated by Omron Healthcare Co. Ltd. The companies that donated the drugs and devices had no role in the design of the study or the analysis of the data. All authors declare no competing interests.

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