Intensive blood pressure control effective in older frail patients, study finds
Data from SPRINT indicated that frail patients were at higher risk for cardiovascular events than nonfrail patients and benefited similarly from a blood pressure target of less than 120 mm Hg, with no significant increase in adverse events.
Older patients with frailty appear to benefit as much from intensive blood pressure control as those without, according to a recent study.
Researchers used data from SPRINT (the Systolic Blood Pressure Intervention Trial) to measure the treatment effects and safety of intensive blood pressure control in patients with and without frailty. Frail or nonfrail status was assigned at baseline according to a frailty index constructed by the SPRINT study group. Patients in SPRINT were randomly assigned to receive standard or intensive blood pressure control (systolic blood pressure targets of <140 mm Hg or <120 mm Hg, respectively). For the current study, the primary outcome was a composite of myocardial infarction, acute coronary syndrome without myocardial infarction, stroke, heart failure, and cardiovascular death. Secondary outcomes were each component of the primary outcome plus all-cause death. Safety outcomes included hypotension, syncope, bradycardia, electrolyte imbalance, injurious fall, acute kidney injury, low sodium, low potassium, and excessive potassium. Results were published July 4 by Circulation.
Overall, 9,306 patients were included in the study, 2,560 (26.7%) with frailty. The mean age was 67.9 years, and 33.5% were women. The primary outcome was observed 561 times over a median follow-up of 3.22 years, and in both the intensive and standard blood pressure control arms, patients with frailty were at significantly higher risk (adjusted hazard ratios, 2.10 [95% CI, 1.59 to 2.77] and 1.85 [95% CI, 1.46 to 2.35], respectively). The effects of intensive treatment did not differ significantly between frail and nonfrail patients on a relative or absolute scale, with the exception of cardiovascular mortality, which did not show the significant effect in frail patients that it did in nonfrail patients (hazard ratios, 0.91 [95% CI, 0.52 to 1.60] and 0.30 [95% CI, 0.16 to 0.59], respectively; P=0.01 for the interaction). In addition, no significant interaction was seen between frailty and risk for serious adverse events with intensive treatment.
Limitations of the study included that frailty was determined retrospectively at baseline and that only approximately 20% of patients in the study were older than age 80 years. “Although patients with frailty are more likely to develop cardiovascular events, especially ADHF [acute decompensated heart failure], they still experience benefits from more intensive [blood pressure] lowering without unnecessarily higher risks of serious adverse events,” the authors wrote. They noted that patients with frailty are often not included in randomized controlled trials and called for more reliable evidence to support decision making in frail elderly populations.