Intensive BP treatment with a systolic BP target below 140 mm Hg was significantly associated with a 21% reduction in MACE (hazard ratio, 0.79 95% CI, 0.71-0.88 P < .001). Results Six trials (original data from 2 trials and reconstructed data from 4 trials) with 27 414 participants (mean age, 70 years 56.3% were women) were included in the analysis. Main Outcomes and Measures Major adverse cardiovascular event (MACE) defined by each trial, which was broadly similar with all trials including myocardial infarction, stroke, and cardiovascular mortality. Published trials were identified by searching PubMed until October 15, 2021.Įxposures Intensive BP lowering vs standard BP lowering with the treat-to-target design. Patient-level survival data were reconstructed when the original data were not available. Objective To estimate the time needed to potentially derive clinical benefit from intensive BP treatment in patients 60 years and older.ĭesign, Setting, and Participants This secondary analysis included individual patient data from published randomized clinical trials with 27 414 patients 60 years or older with hypertension. Therefore, harms with low chance of benefit need to be clearer, particularly for those with limited life expectancy. However, harms from intensive BP treatments occur immediately (eg, syncope, fall), and benefits for cardiovascular event reduction emerge over time. Importance Recent guidelines recommend a systolic blood pressure (BP) goal of less than 150 mm Hg or even 130 mm Hg for adults aged 60 years or older.
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