2026, Number 3
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Acta Med 2026; 24 (3)
Primum non nocere: blood pressure targets in the elderly
Pérez GCC, Zavala JLF, Reséndiz BM
Language: Spanish
References: 12
Page: 329-331
PDF size: 522.03 Kb.
ABSTRACT
The Systolic Blood Pressure Intervention Trial (SPRINT) clinical trial demonstrated that intensive treatment of systolic blood pressure (< 120 mmHg) in older adults is associated with a significant reduction in cardiovascular events and mortality. However, when analyzing the included population and updated results, questions arise regarding the applicability of its conclusions in clinical settings. In this opinion essay, we comment on the SPRINT Senior study, acknowledging the observed benefits while pointing out important limitations such as the exclusion of frail patients, those with multiple comorbidities, or those who are dependent, which restricts the generalizability of the findings to a large proportion of older adults. Moreover, although the study initially reported a 34% reduction in cardiovascular events and a 33% reduction in mortality, the revised 2021 report incorporated additional events, adjusting these results to 27 and 25%, respectively. Additionally, a significant increase in renal impairment was observed in the intensive-treatment group, especially among those without preexisting kidney disease. These findings highlight the need to individualize therapeutic targets in older adults, carefully weighing risks and benefits. We propose a reevaluation of the generalized < 120 mmHg target in this population.
REFERENCES
Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA. 2016; 315 (24): 2673-2682. doi: 10.1001/jama.2016.7050.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. Guía ESC/ESH 2018 sobre el diagnóstico y tratamiento de la hipertensión arterial. Rev Esp Cardiol. 2019; 72 (2): 160.e1-160.e78.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2018; 71 (6): 1269-1324.
Gil G, Gregorio P. Guía de buena práctica clínica en geriatría: hipertensión en el anciano. Madrid (ES): Sociedad Española de Geriatría y Gerontología; 2012.
Shamah-Levy T, Ruiz-Matus C, Rivera-Dommarco J, Kuri-Morales P, Cuevas-Nasu L, Jiménez-Corona ME et al. Encuesta Nacional de Salud y Nutrición de Medio Camino 2016. Resultados nacionales. Cuernavaca, México: Instituto Nacional de Salud Pública; 2017.
Pajewski NM, Williamson JD, Applegate WB, Berlowitz DR, Bolin LP, Chertow GM et al. Characterizing frailty status in the systolic blood pressure intervention trial. J Gerontol A Biol Sci Med Sci. 2016; 71 (5): 649-655. doi: 10.1093/gerona/glv228.
Chang VT, Hwang SS, Feuerman M. Validation of the Edmonton symptom assessment scale. Cancer. 2000; 88 (9): 2164-2171. doi: 10.1002/(sici)1097-0142(20000501)88:9<2164::aid-cncr24>3.0.co;2-5.
Rockwood K, Fox RA, Stolee P, Robertson D, Beattie BL. Frailty in elderly people: an evolving concept. CMAJ. 1994; 150 (4): 489-495.
Díaz de León González E, Gutiérrez Hermosillo H, Martinez Beltran JA, Chavez JH, Palacios Corona R, Salinas Garza DP et al. Validation of the FRAIL scale in Mexican elderly: results from the Mexican Health and Aging Study. Aging Clin Exp Res. 2016; 28 (5): 901-908. doi: 10.1007/s40520-015-0497-y.
Wright JT Jr, Whelton PK, Johnson KC, Snyder JK, Reboussin DM, Cushman WC et al. SPRINT revisited: updated results and implications. Hypertension. 2021; 78 (6): 1701-1710. doi: 10.1161/HYPERTENSIONAHA.121.17682.
World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310 (20): 2191-2194. doi: 10.1001/jama.2013.281053.
Talavera JO, Rivas-Ruiz R, Pérez-Rodríguez M. VI. Relevancia clínica. Rev Med Inst Mex Seguro Soc. 2013; 51 (Supl 1): S42-S46.