Abstract:

Objective To investigate the effect of different antihypertensive therapy levels on composite cardiovascular events in older patients with hypertension. Methods This retrospective study recruited 449 older patients with hypertension （65 ~ 95 years old） who were taking continuous antihypertensive treatment between January 2010 and January 2020. The patients were divided into two groups according to practical blood pressure data for at least one year： group1 224 cases （SBP 110 ~ 130 mmHg） and group 2 225 cases （SBP 130 ~ 150 mmHg）. The primary composite outcome was a composite of acute coronary syndrome， stroke， acute decompensated heart failure， and death from cardiovascular causes. The hazard ratios， 95% confidence intervals， and P value were estimated using the Fine?Gray subdistribution hazard model. The Cox regression model was employed for deaths from any cause. To analyze the effect of two groups antihypertensive therapy levels on the risk of cardiovascular events. Results Primary composite outcome events occurred in 21 of 224 patients （9.3%） in group1（SBP 110 ~ 130 mmHg）， as compared with 28 of 225 patients （12.4%） in group 2 （SBP 130 ~ 150 mmHg） （HR = 0.75， 95%CI： 0.61 ~ 0.94， P = 0.06）. The incidence of primary composite outcome events was significantly lower in group1 than in group 2， with an absolute difference of 3.1 percentage points. The results for individual event of the primary composite outcomes also favored group1. acute coronary syndrome （HR = 0.71， 95%CI： 0.48 ~ 0.96）， stroke （HR = 0.68， 95%CI： 0.46 ~ 0.95）， acute decompensated heart failure （HR = 0.27， 95%CI： 0.08 ~ 0.98）， cardiovascular death （HR = 0.57， 95%CI： 0.39 ~ 0.85）， and all cause death （HR = 0.93， 95%CI： 0.54 ~ 0.97）. The benefit of group1 was significantly better than group 2. Conclusion Systolic blood pressure of 110 ~ 130 mmHg significantly reduces the incidence of cardiovascular events in hypertensive patients over the age of 65 when compared to 130 ~ 150 mmHg.

Key words: hypertension, elderly, different antihypertensive therapy levels, cardiovascular events