Systolic BP of 120 Instead of 140 in High-Risk Older Patients Without Diabetes Leads to Significant Benefits and Some Harms


Am Fam Physician. 2016 Mar 15;93(6):520a-522.

Clinical Question

Is there a net benefit to a systolic blood pressure (BP) target of 120 mm Hg compared with 140 mm Hg in patients without diabetes mellitus who are at high risk of cardiovascular disease?

Bottom Line

In this group of older patients (mean age = 68 years) who do not have diabetes but are at high risk of cardiovascular disease, a more aggressive systolic BP target of 120 mm Hg instead of 140 mm Hg led to benefits (lower all-cause mortality, lower cardiovascular mortality, less heart failure), but also some harms (more serious episodes of hypotension, electrolyte abnormality, syncope, and acute kidney injury). Patients in the intensive therapy group took an average of one additional drug to achieve this target. The decision to pursue this more aggressive target should be guided by how well the patient fits the profile of patients in this study (i.e., no diabetes, older than 50 years, high risk of cardiovascular disease) and how well the additional therapy is tolerated. (Level of Evidence = 1b)


Previous trials of more aggressive BP targets in high-risk patients have shown no benefit or, in some cases, a benefit limited to only one of many possible clinical outcomes (e.g., hemorrhagic stroke only). This study identified patients 50 years and older with a baseline systolic BP between 130 and 180 mm Hg and no history of diabetes or stroke. All were at increased risk of cardiovascular complications based on at least one of the following: cardiovascular disease, chronic kidney disease (glomerular filtration rate [GFR] = 20 to 60 mL

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


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Mar 15, 2017

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