Net Benefit of Intensive BP Lowering in Older Adults

It can be difficult to balance the benefits and risks of intensive blood pressure (BP) control in older adults. Mitra Jamshidian and fellow researchers evaluated data from the multicenter, randomized, double-blind SPRINT study to determine the net benefit of intensive BP lowering (systolic BP <120 mmHg) in older patients.

The researchers used harm-tolerant and harm-averse preference weighting systems to assess the net benefits of intensive BP lowering and conducted subgroup analyses based on age, frailty, and polypharmacy. Their findings were presented during the National Kidney Foundation Spring Clinical Meetings.

All study participants had a predicted net benefit >0% from intensive BP control; that figure was greater for patients aged ≥75 years compared with those aged 65-74 years (median predicted net benefit, 7.4% vs 3.4%; P<.001). With harm-averse weighting, the median predicted net benefit shifted, with 97.0% of participants aged ≥65 years and 99.7% of patients aged ≥75 years receiving a net benefit. Stratification found larger net benefits for older, more frail individuals with polypharmacy versus younger, fitter individuals with lower medication use.

The results largely favored intensive BP control in older adults. However, the researchers pointed out, “Personalizing BP targets for older adults according to each persons’ estimated risks and preferences may provide more refined BP target recommendations.”

Source: Jamshidian M, Scherzer R, Estrella M, Shlipak M, Ascher S. Individualized net benefit of intensive blood pressure of SPRINT participants aged ≥65 years stratified by frailty and polypharmacy. Presented at the National Kidney Foundation Spring Clinical Meetings 2024; May 14-18, 2024; Long Beach, California.