International Society of Hypertension global hypertension guidelines1 and European Society of Cardiology guidelines2 both recommend that hypertension be diagnosed if a patient’s systolic blood pressure is ≥140 mmHg and/or their diastolic blood pressure is ≥90 mmHg. Researchers wondered if pharmaceutical intervention at a lower systolic blood pressure could further reduce the risk of cardiovascular events.
The STEP trial3(NCT03015311) was a prospective, multicentre trial conducted in China which randomized 8511 elderly patients (60 to 80 years of age) with hypertension to undergo intensive blood pressure management (n=4243) or standard blood pressure management (n=4268). Targeting a blood pressure of 110 to <130 mmHg was defined as intensive treatment while targeting a blood pressure of 130 to <150 mm Hg was defined as standard treatment. Patients received olmesartan medoxomil or amlodipine besylate as initial therapy; other drugs, such as hydrochlorothiazide and β-blockers, were allowed if needed, to reach the target systolic blood pressure. The primary outcome was a composite of stroke, acute coronary syndrome (ACS), hospitalization for decompensated heart failure (HF), coronary revascularization, atrial fibrillation, and cardiovascular death (CVD).
After a median follow-up period of 3.34 years, 147 patients (3.5%) in the intensive treatment group had experienced a primary outcome event, as compared with 196 patients (4.6%) in the standard treatment group (hazard ratio 0.74; 95% confidence interval 0.60-0.92, p=0.007). The incidence of the individual components of the primary outcome were also lower in the group receiving intensive treatment.
There were no significant differences in adverse events between the groups, with the exception of hypotension, which occurred more frequently in the intensive treatment group. Researchers concluded that in older adults with hypertension in China, intensive treatment targeting a systolic blood pressure of 110 to <130 mmHg reduced the risk of cardiovascular events, as compared with standard treatment.
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Author: Kelly Schoonderwoerd