Author + information
- Yuli Huang, MD, PhD∗ (, )
- Meijun Li, MD and
- Weijun Huang, MD
- ↵∗Department of Cardiology, Shunde Hospital, Southern Medical University, Penglai Road, Daliang Town, Shunde District, Foshan, 528300, PR China
The meta-analysis by Bavishi et al. (1) showed that in older hypertensive patients, intensive blood pressure (BP) control decreased major adverse cardiovascular events, whereas the risk of renal failure maybe increased. We wish to discuss some of our views.
First, meta-analysis is considered as the highest level of evidence for guiding clinical practice by professional societies. However, in Bavishi’s analysis, only 4 studies were included, and these studies were with significant heterogeneity, such as differences in trial design, inclusion criteria, and baseline characteristics (2). If clinical heterogeneity cannot be well settled in a meta-analysis, the results should be interpreted with caution.
Second, in the recent clinical practice guideline from the American College of Physicians (3), data from 6 studies showed that lower systolic BP targets (<140 mm Hg) showed no statistically significant reduction in all-cause mortality or cardiac events. In patients with a history of stroke or transient ischemic attack, treating to a systolic BP of 130 to 140 mm Hg reduced stroke recurrence. The different conclusions in the 2 studies may be caused by a difference in the studies included for analysis.
Third, older people are with multiple chronic conditions, such as coronary heart disease, diabetes, chronic kidney disease, and frailty. However, there are little data for determining the optimal BP target (4). Furthermore, to achieve the target BP in elderly patients with chronic conditions, it should be achieved by careful titration of medications and monitoring for side effects.
In conclusion, considering the great clinical heterogeneity among the trials included in Bavishi et al.’s analysis, the results should be interpreted with caution. Emphasizing an individualized target BP weighing side effects and treatment effort may be much more proper than advocating intensive BP lowering.
Please note: This work is supported by the Key Specialist Department Training Project of Foshan City, Guangdong, China (No:FSPY3-2015034). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper; and Stanley Franklin, MD, served as Guest Editor for this paper.
- 2017 American College of Cardiology Foundation
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