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Table 2 Results from randomized controlled trials and cohort studies among oldest-old patients

From: Screening and treatment of hypertension in older adults: less is more?

Study acronym or first author, country, publication year Population Intervention or exposure BP category Comparison or reference BP category Outcomes (mortality and CVD) Conclusion
Randomized controlled trials
SPRINT, USA, 2016 [39] ≥ 75 years; N = 2636
Condition: hypertension but no diabetes
Intensive treatment: SBP targets < 120 mmHg Standard treatment: SBP targets < 140 mmHg HR (95% CI) for all-cause mortality: 0.67 (0.49–0.91)
HR (95% CI) for composite CVD events (primary endpoint): 0.66 (0.51–0.85)
More intensive treatment among adults aged 75 years or older significantly reduced the rates of fatal and nonfatal major cardiovascular events and death from any cause, irrespective of frailty status
HYVET, Europe, China, Australasia, and Tunisia, 2008 [38] 80 years or older; N = 3845
Condition: sustained SBP of ≥ 160 mmHg
Active treatment Placebo HR (95% CI) for all-cause mortality: 0.79 (0.65–0.95)
HR (95% CI) for fatal and nonfatal stroke (primary endpoint): 0.70 (0.49–1.01)
Active treatment in persons 80 years of age or older reduced the rate of death from any cause and cardiovascular events, irrespective of frailty status
Population-based observational studies
Streit, the Netherlands, 2018 [50] ≥ 85 years; N = 570
Setting: population-based Leiden 85-plus cohort study
10 mmHg lower SBP HR (95% CI) for all-cause mortality in participants with and without antihypertensive treatment: 1.29 (1.15–1.46) and 1.08 (1.00–1.18) In persons aged 85 years and over, lower SBP was associated with higher all-cause mortality in participants prescribed antihypertensive therapy, irrespective of grip strength, used as a frailty indicator; in participants not prescribed antihypertensive therapy, there was no association between SBP and mortality
Ravindrarajah, UK, 2017 [42] ≥ 80 years; N = 144,403 SBP: (a) < 110, (b) 110–119, (c) 140–159, (d) ≥ 160 mmHg SBP 120–139 mmHg (ref) HR (95% CI) for all-cause mortality in treated fit women: (a) 1.86 (1.39–2.47), (b) 1.48 (1.23–1.79), (ref) 1, (c) 0.76 (0.70–0.84), and (d) 0.85 (0.75–0.96)
HR (95% CI) for all-cause mortality in treated frail women: (a) 1.98 (1.53–2.56), (b) 1.44 (1.24–1.70), (ref) 1, (c) 0.80 (0.72–0.89), and (d) 0.97 (0.82–1.15)
In persons aged 80 years and over, lower SBP was associated with increased mortality rates, and lowest mortality rates were found in patients with baseline SBP between 140 and 159 mmHg; frail adults had higher mortality rates but the association with BP was similar compared with non-frail adults
Post Hospers, the Netherlands, 2015 [48] ≥ 80 years; N = 464
Setting: subpopulation of Longitudinal Aging Study Amsterdam
SBP (a) ≤ 120, b) > 140 mmHg; DBP (c) ≤ 70, (d) > 90 mmHg SBP 121–140 mmHg (ref)
DBP 71–90 mmHg (ref)
HR (95% CI) for all-cause mortality for SBP: (a) 1.16 (0.78–1.73), (ref) 1 and (b) 0.92 (0.71–1.20);
HR (95% CI) for all-cause mortality for DBP: (c) 1.62 (1.23–2.14), (ref) 1, and (d) 0.94 (0.71–1.25)
In persons aged 80 years and over, low DBP was related to an increased all-cause mortality risk
Poortvliet, the Netherlands, 2013 [41] ≥ 90 years; N = 267
Setting: population-based Leiden 85-plus Study
SBP > 150 mmHg SBP ≤ 150 mmHg HR (95% CI) for all-cause mortality in participants with and without heart failure: 1.7 (1.2–2.3) and 2.0 (1.1–3.4) In persons aged 90 years and over, low SBP was associated with increased mortality rates, irrespective of the presence or not of heart failure
Blom, the Netherlands, 2013 [44] ≥ 75 years; N = 851
Condition: without previous CVD; setting: subpopulation of prospective population-based Rotterdam study
SBP (a) 140–159/(b) ≥ 160 mmHg SBP < 140 mmHg HR (95% CI) for all-cause mortality in participants aged 75–84 years: (ref) 1, (a) 1.1 (0.9–1.3), and (b) 1.3 (1.0–1.6)
HR (95% CI) for all-cause mortality in participants aged over 85 years: (ref) 1, (a) 0.7 (0.5–1.1), and (b) 0.7 (0.4–1.1)
After 75 years, high SBP is not associated with an increased mortality risk
Molander, Sweden, 2008 [40] ≥ 85 years; N = 5348 SBP (a) 121–140 /(b) 141–160/(c) > 160 mmHg SBP ≤ 120 mmHg HR (95% CI) for adjusted 4-year mortality: (ref) 1, (a) 0.44 (0.29–0.68), (b) 0.44 (0.29–0.68), and (c) 0.60 (0.37–0.96) Low SBP was associated with increased mortality in persons aged 85 years and older; the optimal SBP for this age group could be > 140 mmHg
van Bemmel, the Netherlands, 2006 [43] ≥ 85 years; N = 571
Setting: population-based Leiden 85-plus Study
SBP (a) < 140 mmHg/(b) ≥ 160 mmHg SBP 140–159 mmHg RR (95% CI) for all-cause mortality: (a) 1.19 (0.79–1.79), (ref) 1, and (b) 0.66 (0.47–0.92) BP < 140/70 mmHg was associated with excess mortality in persons aged 85 years and over
Satish, USA, 2001 [49] ≥ 85 years; N = 1088
Setting: subpopulation of cohort study
10 mmHg higher SBP and 10 mmHg higher DBP SBP and DBP HR (95% CI) of death with higher SBP in men: 0.92 (0.86–0.99) and in women: 1.00 (0.95–1.05)
HR (95% CI) of death with higher DBP in men: 0.90 (0.80–1.02) and in women: 0.99 (0.89–1.10)
In men aged 85 years and older, higher SBP was associated with better survival
Guo, Sweden, 1997 [45] ≥ 75 years; N = 1810
Setting: community-dwelling
SBP (a) < 130/(b) ≥ 160 mmHg; DBP (c) < 75 (d) ≥ 95 mmHg SBP ≥ 130 mmHg; SBP ≥ 75 mmHg RR (95% CI) for death with SBP (a) 1.39 (1.11–1.73), (ref) 1, (b) 1.15 (0.97–1.37) and with DBP (c) 1.21 (1.02–1.43), (ref) 1, and (d) 0.91 (0.71–1.17) In people aged 75 years and older, there was a marked increase in 5-year all-cause mortality with low BP (especially in participants with preexisting CVD, limitation in activities of daily living, and cognitive impairment)
Hakala, Finland, 1997 [46] ≥ 75 years; N = 521 10 mmHg higher SBP and 5 mmHg higher DBP RR (95% CI) for higher SBP: 0.90 (0.85–0.96)
RR (95% CI) for higher DBP: 0.92 (0.68–0.99)
Among subjects aged 75 years and over, high BP was associated with favorable 5-year survival
Mattila, Finland, 1988 [47] ≥ 85 years; N = 561 old people
Setting: community-dwelling persons
SBP (a) < 120/(b) 120–139/(c) 140–159/(d) 160–179/(e) 180–199/(f) > 200 mmHg
DBP (g) < 70/(h) 70–79/(i) 80–89/(j) 90–99/(k) 100–109/(l) > 110 mmHg
Mean survival rates in the Finnish population aged 85 years and over 5-year survival rates (SD) according to SBP level: (a) 0.22 (0.15), (b) 0.59 (0.16), (c) 1.08 (0.13), (d) 1.41 (0.14), (e) 1.32 (0.21), and (f) 1.49 (0.38)
5-year relative survival rates (SD) according to DBP level: (g) 0.72 (0.17), (h) 0.76 (0.18), (i) 1.13 (0.13), (j) 1.35 (0.14), (k) 1.19 (0.23), and (l) 1.54 (0.36)
The lowest survival was observed in individuals with the lowest SBP and DBP; survival was highest in subjects with BP ≥ 160/90 mmHg
  1. HYVET, hypertension in the very elderly trial; SPRINT, systolic blood pressure intervention trial; N, number of participants; BP, blood pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, hazard ratio, CI, confidence interval; ref., reference; CVD, cardiovascular disease