Achieved home systolic blood pressure and cardiovascular risk in older hypertensive patients.

In 30 seconds

This secondary analysis of a randomized controlled trial examined achieved home systolic blood pressure (SBP) and cardiovascular outcomes in older adults with hypertension. Among 7,681 participants, 261 composite cardiovascular events occurred over a median follow-up of 3.43 years. Compared with home SBP ≥135 mmHg, SBP <125 mmHg and 125–130 mmHg were associated with lower risk of the primary outcome: adjusted HRs 0.62 (95% CI, 0.42-0.90) and 0.66 (95% CI, 0.47-0.94), respectively. Lower SBP categories were not associated with a statistically significant increase in the primary safety outcome.

Key findings

• Compared with home SBP ≥135 mmHg, SBP <125 mmHg was associated with lower primary-outcome risk (adjusted HR, 0.62; 95% CI, 0.42-0.90).
• Home SBP of 125–130 mmHg was also associated with lower primary-outcome risk (adjusted HR, 0.66; 95% CI, 0.47-0.94).
• For the primary composite outcome, absolute risk reduction versus SBP ≥135 mmHg was 1.70% with SBP <125 mmHg and 1.36% with SBP 125–130 mmHg.
• Lower home SBP categories were associated with lower stroke risk (adjusted HR, 0.36; 95% CI, 0.19-0.66), without a statistically significant increase in the primary safety outcome.

Why it matters

Home measurements may help characterize blood pressure achieved during treatment in older adults. These findings link levels below 130 mmHg with lower cardiovascular risk than levels ≥135 mmHg, while providing no evidence of a statistically significant increase in the primary safety outcome. The results add evidence relevant to individualized blood pressure targets, particularly where stroke risk and treatment tolerance are considered.

What to keep in mind

This was a secondary analysis using achieved blood pressure categories rather than a randomized comparison of those specific targets; associations therefore do not establish that lowering SBP to a given category caused the outcome differences.