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General medicine
Intensive blood pressure-lowering reduces mortality and cardiovascular events in older people
  1. Emily Atkins
  1. George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
  1. Correspondence to Dr Emily Atkins, George Institute for Global Health, University of New South Wales, Camperdown, NSW 2050, Australia; eatkins{at}georgeinstitute.org.au

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Commentary on: Weiss J, Freeman M, Low A, et al. Benefits and harms of intensive blood pressure treatment in adults aged 60 years or older: a systematic review and meta-analysis. Ann Intern Med 2017;166:419–429.

Context

There has been debate around blood pressure (BP)-lowering targets for older people, with concerns about adverse effects (AEs) such as falls and cognitive changes. The 2014 Eighth Joint National Committee (JNC8) guidelines suggested a less intensive systolic BP (SBP) target of <150 mm Hg for people aged ≥60 years,1 while the 2017 American College of Cardiology/American Heart Association (ACC/ AHA) guidelines recommend target SBP of <130 mm Hg for community-dwelling ambulant adults aged ≥65 years with an average SBP of >130 mm Hg, the same target as those <65 years with high-risk or established cardiovascular disease.2 This change is, in part, because of the strongly positive results seen in elderly participants in the Systolic Blood Pressure Intervention Trial (SPRINT). …

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