Life Expectancy Important When Deciding on Intensive BP Lowering

NEW YORK (Reuters Health) – Starting intensive antihypertensive therapy may be most appropriate for adults expected to live at least three more years. For those with a life expectancy of less than one year, the harms of intensive BP control may outweigh the benefits.

These are the chief findings from a “time to clinical benefit” analysis of individual patient data from six randomized controlled trials with more than 27,000 hypertensive patients aged 60 and older (mean age, 70 years; 56% women).

Overall, intensive BP lowering to a systolic BP target below 140 mm Hg was associated with a significant 21% reduction in major adverse cardiovascular events (MACE).

On average, it took 9.1 months of intensive BP control to prevent one MACE in 500 people, “suggesting that for most patients with a life expectancy of less than one year, the harms of intensive BP control may outweigh its benefits,” Dr. Tao Chen of the University of Liverpool, in the U.K., and colleagues report in JAMA Internal Medicine.

It took 34.4 months to prevent one MACE from intensive BP control for 100 patients, “suggesting that for most patients with a life expectancy greater than three years, the benefits may likely outweigh the harms,” they say.

To their knowledge, this is the first study to use robust quantitative methods to determine the time to benefit for prevention of MACE with intensive BP control in older patients.

The analysis “fills a critical gap for individually weighing benefits against potential harms while considering intensive BP control in this population, especially those with limited life expectancy,” Dr. Chen and colleagues say.

They caution that “the degree to which an individual patient will benefit from intensive BP control will likely depend on their risk profile and potential harm.”

“These results reinforce the importance of individualizing intensive BP control decisions by incorporating each patient’s values and preferences,” they add.

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: JAMA Internal Medicine, online May 9, 2022.

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