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Hot Line - Does intensive BP reduction benefit older patients with hypertension?

30 Aug 2021
Hot Line presented at ESC Congress

Yes, according to the findings of the STEP study, presented by Professor Jun Cai (Chinese Academy of Medical Sciences, Beijing, China) in a Hot Line session today.

The STEP study investigated whether intensive treatment (systolic blood pressure [SBP] target below 130 mmHg but no lower than 110 mmHg) could reduce the risk of cardiovascular (CV) events compared with standard treatment (SBP target 130–150 mmHg).

In total, 8,511 patients aged 60–80 years with SBP 140–190 mmHg during three screening visits or who were taking antihypertensive medication were randomised. All patients had regular follow-up clinic visits and the same validated office BP measurement device was used at collaborating hospitals. A smartphone-based app was used to examine home BP changes as an adjunct to office BP during follow-up.

The primary outcome was a composite of stroke, acute coronary syndrome (ACS), acute decompensated heart failure, coronary revascularisation, atrial fibrillation, or death from CV causes. Secondary outcomes included the individual components of the primary endpoint, death from any cause, major adverse cardiac events and renal outcomes (a decrease in renal function or the development of end-stage renal disease).

Over a median follow-up period of 3.34 years, the mean reduction in SBP from baseline was 19.4 mmHg with intensive treatment and 10.1 mmHg with standard treatment. Average SBP was 126.7 mmHg and 135.9 mmHg in the intensive and standard groups, respectively, with an average between-group difference of 9.2 mmHg.

Intensive treatment was associated with a 26% relative-risk reduction in the number of primary outcome events compared with standard treatment (3.5% vs. 4.6%; hazard ratio 0.74; 95% confidence interval [CI] 0.60 to 0.92). Intensive treatment was also associated with a 33% lower relative risk of stroke (95% CI 0.47 to 0.97) and a 33% lower relative risk of ACS (95% CI 0.47 to 0.94). The incidence of safety outcomes and renal outcomes did not differ between the groups, except for hypotension, which occurred in 3.4% of patients in the intensive group and 2.6% in the standard group (p=0.03).

“Active control of SBP to below 130 mmHg in older hypertensive patients, as compared with below 150 mmHg, resulted in a lower incidence of major CV events, with no increase in renal injuries,” said Prof. Cai. “Home BP monitoring more accurately reflected long-term fluctuations in BP than office measurements,” he added.


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