Targeting a systolic blood pressure of <130 mmHg is beneficial in adults with hypertension aged ≥75 years: a systematic review and meta-analysis

Recent clinical trials have raised important questions regarding optimal blood pressure (BP) targets in older adults with hypertension. In the 2019 Japanese Society of Hypertension guidelines, a systolic BP (SBP) target of <140 mmHg is recommended for individuals aged ≥75 years. However, subsequent randomized controlled trials (RCTs) have shown potential cardiovascular and mortality benefits associated with strict BP targets. We conducted an updated systematic review and meta-analysis to evaluate the efficacy and safety of intensive SBP control (<130 mmHg) compared with less intensive control (≥130 mmHg) in patients with hypertension aged ≥75 years. We searched MEDLINE, Cochrane Library, and Ichushi Web for publications up to May 30, 2024, supplemented by manual searches. Seven RCTs that met predefined eligibility criteria were included in the final meta-analysis. Among patients aged ≥75 years, intensive SBP lowering was associated with significantly reduced risks of composite cardiovascular events (risk ratio [RR]: 0.61, 95% confidence interval [CI]: 0.40–0.94, p = 0.03), all-cause mortality (RR: 0.72, 95% CI: 0.56–0.93, p = 0.01), and cardiovascular mortality (RR: 0.55, 95% CI: 0.35–0.88, p = 0.01), with no increase in serious adverse events (RR: 1.00, 95% CI: 0.93–1.08, p = 0.97). Stroke incidence did not differ significantly between groups. Similar results were observed when the analysis was expanded to include studies that enrolled participants aged ≥70 years. These findings support the safety and clinical benefits of targeting an SBP of <130 mmHg in older adults with hypertension.