Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial

被引：62

作者：

Pajewski, Nicholas M. ^{[1
]}

Berlowitz, Dan R. ^{[2
,3
]}

Bress, Adam P. ^{[4
]}

Callahan, Kathryn E. ^{[6
]}

Cheung, Alfred K. ^{[7
]}

Fine, Larry J. ^{[8
]}

Gaussoin, Sarah A. ^{[1
]}

Johnson, Karen C. ^{[9
]}

King, Jordan ^{[5
]}

Kitzman, Dalane W. ^{[10
]}

Kostis, John B. ^{[11
]}

Lerner, Alan J. ^{[12
]}

Lewis, Cora E. ^{[13
]}

Oparil, Suzanne ^{[14
]}

Rahman, Mahboob ^{[15
]}

Reboussin, David M. ^{[1
]}

Rocco, Michael V. ^{[16
]}

Snyder, Joni K. ^{[17
]}

Still, Carolyn ^{[18
]}

Supiano, Mark A. ^{[19
,20
]}

Wadley, Virginia G. ^{[20
]}

Whelton, Paul K. ^{[21
]}

Wright, Jackson T., Jr. ^{[22
]}

Williamson, Jeff D. ^{[6
]}

机构：

[1] Wake Forest Sch Med, Dept Biostat & Data Sci, Winston Salem, NC 27101 USA

[2] Bedford Vet Affairs Hosp, Bedford, MA USA

[3] Univ Massachusetts, Dept Publ Hlth, Lowell, MA USA

[4] Univ Utah, Sch Med, Dept Populat Hlth Sci, Salt Lake City, UT USA

[5] Kaiser Permanente Colorado, Inst Hlth Res, Aurora, CO USA

[6] Wake Forest Sch Med, Sect Gerontol & Geriatr Med, Dept Internal Med, Winston Salem, NC USA

[7] Univ Utah, Sch Med, Div Nephrol & Hypertens, Salt Lake City, UT USA

[8] NHLBI, Clin Applicat & Prevent Branch, Bldg 10, Bethesda, MD 20892 USA

[9] Univ Tennessee, Hlth Sci Ctr, Dept Prevent Med, Memphis, TN USA

[10] Wake Forest Sch Med, Dept Internal Med, Sect Cardiovasc Med, Winston Salem, NC 27101 USA

[11] Rutgers Robert Wood Johnson Med Sch, Cardiovasc Inst, New Brunswick, NJ USA

[12] Case Western Reserve Univ, Sch Med, Dept Neurol, Cleveland, OH 44106 USA

[13] Univ Alabama Birmingham, Dept Epidemiol, Birmingham, AL USA

[14] Univ Alabama Birmingham, Dept Med, Birmingham, AL 35294 USA

[15] Case Western Reserve Univ, Louis Stokes Cleveland Vet Affairs Med Ctr, Dept Med, Cleveland, OH 44106 USA

[16] Wake Forest Sch Med, Dept Internal Med, Nephrol Sect, Winston Salem, NC 27101 USA

[17] NHLBI, Div Cardiovasc Sci, Bldg 10, Bethesda, MD 20892 USA

[18] Case Western Reserve Univ, Frances Payne Bolton Sch Nursing, Cleveland, OH 44106 USA

[19] Univ Utah, Div Geriatr, Sch Med, Salt Lake City, UT USA

[20] Vet Affairs Salt Lake City Hlth Care Syst, Geriatr Res Educ & Clin Ctr, Salt Lake City, UT USA

[21] Tulane Univ, Sch Publ Hlth & Trop Med, Dept Epidemiol, New Orleans, LA 70118 USA

[22] Case Western Reserve Univ, Div Nephrol & Hypertens, Dept Med, Cleveland, OH USA

来源：

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY | 2020年 / 68卷 / 03期

基金：

美国国家卫生研究院;

关键词：

cardiovascular disease; hypertension; older adults; cognitive function; FUNCTIONAL STATUS; HYPERTENSION; ASSOCIATION; HEALTH; AGE; STRATEGIES; MORTALITY; DISEASES; VALUES;

D O I：

10.1111/jgs.16272

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

OBJECTIVES To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function. DESIGN Secondary analysis. SETTING Systolic Blood Pressure Intervention Trial (SPRINT) PARTICIPANTS Adults 80 years or older. INTERVENTION Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment). MEASUREMENTS We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4-m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function. RESULTS Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49-.90), mortality (HR = .67; 95% CI = .48-.93), and MCI (HR = .70; 95% CI = .51-.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28-.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87-2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between-group differences in the rate of injurious falls. CONCLUSION In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function. Trial Registration identifier: NCT01206062.

引用

页码：496 / 504

页数：9

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