Optimizing systolic blood pressure targets for elderly hypertensive patients: a meta-analysis of mortality, cardiovascular outcomes, and adverse events

Abstract

Background: Hypertension is a common health issue among elderly populations, substantially increasing morbidity and mortality risks. This meta-analysis aimed to determine optimal systolic blood pressure (SBP) targets in elderly hypertensive patients and their effects on clinical outcomes. Methods: We conducted a systematic search of PubMed, Embase, and the Cochrane Library to identify randomized controlled trials involving antihypertensive therapy in participants aged 60 years and older. Mortality, cardiovascular events, and significant adverse events data were extracted and analyzed using random-effects models. Results: The analysis included 24 studies, with 9 specifically examining elderly participants aged 60 and older. Targeting a lower SBP of less than 140 mmHg was associated with significant reductions in primary outcome events (relative risk [RR], 0.69; 95% confidence interval [CI], 0.56–0.86), all-cause mortality (RR, 0.64; 95% CI, 0.49–0.83), cardiovascular mortality (RR, 0.59; 95% CI, 0.39–0.87), and stroke (RR, 0.68; 95% CI, 0.47–0.98; I2 = 0%). Achieving an intensive SBP target in the pooled range less than 130 mmHg reduced the risks of primary outcome events (RR, 0.73; 95% CI, 0.62–0.85), heart failure (RR, 0.57; 95% CI, 0.38–0.84), and stroke (RR, 0.72; 95% CI, 0.53–0.96), though it also led to an elevated risk of hypotension (RR, 1.43; 95% CI, 1.18–1.73). Conclusions: In elderly hypertensive patients, lower SBP targets correlate with improved clinical outcomes, including reduced mortality and cardiovascular events. Nonetheless, the heightened risk of adverse effects underscores the need for careful, individualized treatment strategies. Additional research is warranted to refine these targets and achieve a balance between therapeutic efficacy and safety.