Data are sparse regarding on-treatment blood pressure (BP) levels at which cardiovascular disease (CVD) and all-cause mortality risks are minimized in older adults with isolated systolic hypertension (ISH). Our aim was to assess optimal on-treatment BP in older Japanese adults with ISH.Design and Method:
We used data from the Valsartan in Elderly Isolated Systolic Hypertension (VALISH) Study, which recruited older adults (n = 3,035; mean age: 76 years) with systolic BP (SBP)>160 mmHg and diastolic BP (DBP) < 90 mmHg. Patients were randomly assigned to receive intensive (SBP target < 140 mmHg) or moderate (>140 and < 150 mmHg) BP-lowering treatment with Valsartan, and were also categorized into three groups based on their achieved on-treatment SBP: those with SBP < 130 mmHg (n = 317), 130 to <145 mmHg (n = 2,025), or >145 mmHg (n = 693). The primary outcome was composite CVD (coronary heart disease, stroke, heart failure, cardiovascular deaths, other vascular diseases, and kidney diseases) and the secondary outcome was all-cause mortality. Cox proportional hazards models were used to assess the CVD risk for each group.Results:
Over a median 3-year follow-up (8022.13 person-years), 93 CVD events and 52 deaths occurred. With on-treatment SBP of 130 to <145 mmHg as the reference stratum, the multivariable-adjusted hazard ratios and 95% confidence intervals of CVD and all-cause mortality risks for those with on-treatment SBP<130 were 2.08 (1.12–3.83) and 2.09 (0.93–4.71), and for those with on-treatment SBP>145 mmHg were 2.29 (1.44–3.62) and 2.51 (1.35–4.66), respectively (Figure 1). Results were similar by baseline clinical characteristics (i.e., sex, <80 years and >80 years, and prevalent diabetes or CVD). On-treatment DBP yielded no relationships with CVD or all-cause mortality risk.Conclusions:
A J-shaped relationship was observed between on-treatment SBP and CVD and all-cause mortality risk in older adults with ISH. On-treatment SBP of 130 to <145 mmHg was associated with minimal adverse outcomes.