Hypertension is a very common chronic illness in the United States and among Veterans. Use of antihypertensive medications can lower the risk of cardiovascular disease, cerebrovascular disease, renal disease, and death. The most beneficial blood pressure targets for patients of specific age groups, however, has been a topic of some debate and controversy, stemming from concerns that the ratio of benefit to harm of a given blood pressure level may vary with age. In 2014, the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (previously JNC-FG8, referred to in this report as JNC-BP) published new guidelines for the treatment of hypertension, as well as a new treatment goal for older individuals (over age 60) for systolic blood pressure (SBP) of < 150 mm Hg rather than < 140 mm Hg. The new goal for those over 60 years of age has been very controversial; the issue of the appropriate (safest and most beneficial) goal for older people has been debated among experts with viewpoints supporting both higher and lower treatment goals. The objectives of this review are to examine the benefits and harms of differing blood pressure targets among adults over age 60.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • SUMMARY OF EVIDENCE AND DISCUSSION
• ABBREVIATIONS
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1. In adults over age 60, what are the health outcome effects of differing blood pressure targets?
  • KEY QUESTION 1B. In patients who have suffered a TIA or stroke, does treatment of blood pressure to specific targets affect outcomes?
  • KEY QUESTION 2. How does age modify the benefits of differing blood pressure targets?
  • KEY QUESTION 3. How does the patient burden of comorbidities modify the benefits of differing blood pressure targets?
  • KEY QUESTION 4. What are the harms of targeting lower blood pressure in older patients? Do the harms vary with age?
  • KEY QUESTION 5. Do the harms of targeting lower blood pressure vary with patient burden of comorbidities?
• SUMMARY AND DISCUSSION
  • LIMITATIONS
  • FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A. SEARCH STRATEGIES
• APPENDIX B. STUDY SELECTION
• APPENDIX C. QUALITY ASSESSMENT
• APPENDIX D. DATA SUPPLEMENT
• APPENDIX E. PEER REVIEWER COMMENTS AND AUTHOR RESPONSES

Suggested citation:

Weiss J, Kerfoot A, Freeman M, Motu'apuaka M, Fu R, Low A, Paynter R, Kondo K, Kansagara D. Benefits and harms of treating blood pressure in older adults: a systematic review and meta-analysis. VA ESP Project #05-225; 2015.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the VA Portland Health Care System, Portland, OR, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.