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

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

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