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\begin{document}

\title{Intensive blood pressure control for patients over age 60: a pooled
analysis of the SPRINT, STEP, and ACCORD BP randomized controlled trials}



\author[1]{Xiaoting Li}%
\author[1]{Jiejun Zhang}%
\author[1]{Zhenhua Xing}%
\author[1]{Qiming Liu}%
\author[2]{Shenghua Zhou}%
\author[1]{Yichao Xiao}%
\affil[1]{The Second Xiangya Hospital of Central South University}%
\affil[2]{Affiliation not available}%


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  \date{May 25, 2024}


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\begin{abstract}
Abstract Aim: Blood pressure-lowering treatment is beneficial for
preventing cardiovascular disease risk among elderly patients. However,
the most appropriate BP targets for elderly patients are controversial.
Methods: We extracted the individual-level data of participants over 60
years from the SPRINT study and ACCORD study first and then conducted a
meta-analysis of major adverse cardiovascular events (MACEs) and adverse
events (hypotension and syncope) and renal outcomes across the SPRINT,
STEP, and ACCORD BP trials, which included 18,806 participants over 60.
Participants were randomized to receive standard BP treatment or
intensive BP treatment. Results: In this meta-analysis, intensive
treatment exhibited a nominal trend toward decreases in all-cause death
(hazard ratio {[}HR{]}: 0.98; 95\% confidence interval {[}CI{]}:
0.76-1.26; p=0.87) and cardiovascular mortality (HR: 0.77; 95\%CI:
0.54-1.08; p=0.13). The incidence of MACEs (HR: 0.83; 95\%CI: 0.74-0.94;
p=0.003) and stroke (HR: 0.70; 95\% CI: 0.56-0.88; p=0.002) was reduced.
Intensive treatment had an inconspicuous effect on coronary disease (HR:
0.87; 95\% CI: 0.69-1.10; p=0.24) and heart failure (HR: 0.70; 95\%CI:
0.40-1.22; p=0.21). Intensive treatment increased the risk of
hypotension (HR: 1.46; 95\%CI: 1.12-1.91; p=0.006) and syncope (HR:
1.43; 95\%CI: 1.06-1.93; p=0.02). Intensive treatment did not increase
the risk of either impaired kidney function among patients with chronic
kidney disease (CKD) (HR: 0.98; 95\% CI: 0.41-2.34; p=0.96) or without
CKD (HR: 1.77; 95\%CI: 0.48-6.56; p=0.40) at baseline. Conclusions:
Intensive BP goals reduced the incidence of MACEs and increased the risk
of adverse events without significant mortality or renal outcome
changes.%
\end{abstract}%



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