Target blood pressure level for the treatment of elderly hypertensive patients: a systematic review and meta-analysis of randomized trials

Although recent systematic reviews (SRs) of randomized clinical trials (RCTs) support the benefit of blood pressure (BP) treatment in the elderly, the optimized target BP level remains controversial. We performed a SR to determine the clinical benefit of antihypertensive treatments with a target systolic BP (SBP) of <140 mmHg in the elderly. We searched for RCTs comparing intensive and less intensive treatments or placebo and active treatments reported until May 2017 and identified 11 RCTs in which the target or on-treatment SBP in the intensive or active treatment was less than 140 mmHg. Among the RCTs, 6 RCTs with primary or subanalysis results for patients aged 70 years or older were finally chosen for the meta-analysis. We found that intensive lowering of BP did not reduce the risk ratio (RR) of composite cardiovascular outcomes (95% CI: 0.67-1.05, p = 0.13). By contrast, intensive lowering of BP achieved RR reductions of 24% for all-cause death (0.63-0.92) and of 39% for cardiovascular death (0.48-0.77). Intensive lowering of BP did not alter the incidence of stroke (0.63-1.23) and serious adverse events (SAEs) (0.93-1.09). In conclusion, intensive antihypertensive regimens targeting SBP <140 mmHg did not significantly reduce the risk of cardiovascular diseases compared to that of less intensive treatments, but did reduce the risk of death without increasing adverse events in patients aged 70 years or older. These findings support the benefit of intensive treatment targeting SBP to <= 140 mmHg in the elderly.