State Key Laboratory of Cardiovascular Disease, Hypertension Center, FuWai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beilishi Road 167, Xicheng District, 100037, Beijing, China.
Hypertens Res. 2022 Apr;45(4):576-582. doi: 10.1038/s41440-022-00875-7. Epub 2022 Mar 11.
With a rapidly aging population, adequate blood pressure (BP) control is critical for hypertension management and prevention of cardiovascular events. Impressive cardiovascular benefits have been observed with intensive BP control (SBP target, <120 mmHg) in the SPRINT (Systolic Blood Pressure Intervention Trial) study, even in patients 75 years of age or older. A most recent meta-analysis including 51 randomized trials with over 350,000 participants from the BPLTTC (The Blood Pressure Lowering Treatment Trialists' Collaboration) showed that BP lowering is effective in older people for reducing major cardiovascular events. The STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) study-a multicenter, randomized, controlled trial conducted in China, provided important evidence that intensive BP treatment (SBP target, 110 mmHg to <130 mmHg) benefits older hypertensive patients (aged 60-80 years) and reduced the incidence of cardiovascular events than standard treatment (target 130 mmHg to <150 mmHg). Because Asian people have a higher burden of hypertension and stroke than Caucasian people, intensive BP treatment has more advantages in reducing the risk of cardiovascular events including stroke in Asian hypertensive patients than in Caucasian people. Home BP monitoring is helpful to facilitate hypertension management for older patients. It should also be noted that clinical decision-making should be on a patient basis, such as fragility, diabetes, stroke, and other comorbidities, with tailored BP targets. Here we review the important clinical trials of BP control in elderly hypertension, interpretate the main findings of STEP, and also discuss the perspectives of managing hypertension in Asia.
随着人口老龄化的加速，充分控制血压（BP）对于高血压管理和预防心血管事件至关重要。SPRINT（收缩压干预试验）研究表明，强化血压控制（SBP 目标<120mmHg）可显著带来心血管获益，即使在 75 岁及以上的患者中也是如此。BPLTTC（降压治疗试验者协作）的一项最新荟萃分析纳入了 51 项随机试验，共涉及 35 万多名参与者，结果表明降压治疗在老年人中可有效减少主要心血管事件。STEP（老年高血压患者血压干预策略）研究是在中国进行的一项多中心、随机、对照试验，提供了重要证据，表明强化血压治疗（SBP 目标 110mmHg 至<130mmHg）有益于老年高血压患者（年龄 60-80 岁），并降低心血管事件发生率，优于标准治疗（目标 130mmHg 至<150mmHg）。由于亚洲人群的高血压和卒中负担高于白种人，因此在亚洲高血压患者中，强化血压治疗在降低心血管事件风险（包括卒中）方面比在白种人中更具优势。家庭血压监测有助于老年患者的高血压管理。还应注意的是，临床决策应基于患者情况，如脆弱性、糖尿病、卒中及其他合并症，制定个体化的血压目标。本文我们回顾了老年高血压血压控制的重要临床试验，解释了 STEP 的主要发现，并讨论了亚洲高血压管理的前景。
