The data presented by these researchers is a compelling argument for the importance of hypertension in cardiovascular aging. Hypertension as a result of intrinsic aging processes is probably largely caused by stiffening of blood vessels, but narrowing of vessels due to atherosclerosis and other more general consequences of metabolic dysfunctions, such as those that result from being overweight, also play a part. The cardiovascular system remodels in response to hypertension, and is damaged, producing a variety of forms of cardiovascular disease. In addition, a faster pace of rupture of tiny vessels in the brain due to stiffening and increased pressure leads to dementia. All of these are good reasons to work at maintaining a lower blood pressure throughout later life, and more importantly to support the development of therapies capable of reversing the causes of blood vessel stiffening, such as glucosepane cross-link breakers.
Intensive therapies to reduce high blood pressure can cut the risk of heart disease in older adults without increasing the risk for falls. In the United States, 75 percent of people over age 75 have hypertension, which can lead to cardiovascular disease, a leading cause of disability, morbidity and death. Current guidelines have provided inconsistent recommendations regarding the optimal systolic blood pressure (SBP) treatment target in geriatric populations. The latest findings from the Systolic Blood Pressure Intervention Trial (SPRINT), which focused on ambulatory adults 75 or older, showed that adjusting the amount or type of blood pressure medication to achieve a target systolic pressure of 120 millimeters of mercury (mm Hg) reduced rates of cardiovascular events - heart attack, heart failure and stroke - by almost a third and the risk of death by almost a quarter, as compared to a target systolic pressure of 140 mm Hg.
The 2,636 participants were randomized to an intensive target systolic blood pressure (SBP) treatment target of 120mmHg or the standard target of SBP of 140 mmHg. People with diabetes or heart failure were not included in the trial. At the beginning of the study, people underwent blood pressure measurement three times in a quiet room, completed a walking test to determine gait speed, and responded to a questionnaire to categorize their level of frailty. Blood pressure was rechecked every three months and medication adjusted as needed. Both groups also were checked for eight potential complications of lower blood pressure, such as hospitalizations, falls, acute kidney injury and fainting. The researchers found no difference between the two groups in these areas. On average, persons in the lower blood pressure goal group required one additional medication to reach goal.
"These findings have substantial implications for the future of high blood pressure therapy in older adults because of its high prevalence in this age group, and because of the devastating consequences high blood pressure complications can have on the independent function of older people. Most of the medications used in SPRINT were generic, so this is a fairly inexpensive way to help prolong the time that people can live independently in their homes and avoid those common conditions that often cause a person to have to move to higher level of care or an institution."
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