Intensive blood pressure control in older patients with hypertension-a STEP in the right direction?

In November 2022, the Clinical Practice Guidelines for the Management of Hypertension in China were updated; the definition of hypertension and the target of treatment was changed from 140/90 mm Hg to 130/80 mm Hg. This was prompted by the results of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) study, a large multicenter randomized controlled trial conducted in China. STEP echoed the results of the American Systolic Blood Pressure Intervention Trial (SPRINT), and confirmed that intense lowering of blood pressure is on the whole beneficial. This confirmation is important for the Chinese population, in which strokes outnumber myocardial infarctions. It is also reassuring to know that treating adults aged 60 years or older to achieve a systolic blood pressure of <130 mm Hg is safe, while reducing cardiovascular events, stroke and all-cause mortality. Nevertheless, further studies are needed to delineate the risks and benefits in subgroups, such as the elderly with diabetes or a history of stroke.