Most Read Articles
13 Sep 2020
Regardless of birth weight, being obese at preschool age is associated with a greater risk of elevated blood pressure during early childhood, a recent China study has found. A longer duration of breastfeeding appears to help mitigate such a risk.
Jairia Dela Cruz, 4 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
06 Sep 2020
Type 2 diabetes mellitus patients taking proton pump inhibitors (PPIs) are at a higher risk of sustaining hip fractures, a recent study has found.
6 days ago
Osteoarthritis (OA) is the most common condition affecting the joints. Dr Lee Eu Jin, an Orthopaedic Surgeon from Liberty Orthopaedic Clinic at Mount Elizabeth Medical Centre, Singapore, shares his insights with Pearl Toh on how to manage OA in the primary care setting.


3-year intensive BP lowering in older hypertensives: No clear benefit on mobility outcomes

Jairia Dela Cruz
28 Oct 2019

In older adults with systolic hypertension, targeting a 24-hour ambulatory systolic blood pressure (BP) of 130 vs ≤145 mm Hg does not appear to be beneficial in terms of mobility outcomes during a 3-year period, although it yields a favourable effect on subcortical white matter disease, according to data from the INFINITY trial.

“These data suggest that 3 years was likely too short a duration for reductions in accrual of white matter hyperintensity to translate to functional benefit,” the authors noted.

INFINITY involved 199 elderly patients (mean age, 80.5 years; 54 percent female) with systolic hypertension (average 24-hour systolic BP, 149 mm Hg) and magnetic resonance imaging evidence of white matter hyperintensity lesions. These patients were randomized to treatment groups targeting a 24-hour mean systolic BP of ≤130 mm Hg (intensive group) or ≤145 mm Hg (standard) with antihypertensive therapies.

Goal BPs were achieved after a median treatment period of 3–4 months, with a median 24-hour systolic BP of 127.7 mm Hg in the intensive treatment group and 144.0 mm Hg in the standard treatment group (average difference, 16.3 mm Hg).

Three-year intensive BP lowering did not produce a significant change in mobility (gait speed) compared with standard treatment (0.40 vs 0.42 s, respectively; p=0.91). However, intensive treatment was associated with less accrual of white matter hyperintensity lesions (0.29 percent vs 0.48 percent; p=0.03). [Circulation 2019;doi:10.1161/CIRCULATIONAHA.119.041603]

Cognitive outcomes were likewise similar in the two treatment groups. Major adverse cardiovascular events occurred with greater frequency in the standard treatment group (17 vs 4 patients; p=0.01). There was no significant between-group difference in the occurrence of falls, with or without injury, and syncope.

“Results of the trial demonstrated a significant impact of lower 24-hour systolic BP on progression of white matter lesions, but it was unaccompanied by a detectable impact on mobility and cognitive function,” the authors said, adding that these data are consistent with findings from a substudy of 192 patients with a history of stroke from the PROGRESS trial (Perindopril Protection Against Recurrent Stroke). [Circulation 2005;112:1644-1650]

They explained that the inability to demonstrate effects on the functional parameters may be attributed to a shorter-term follow-up, given that the accrual of white matter hyperintensity volume occurs silently for many years. “[This is] compounded by the requirement that patients entering INFINITY had intact mobility, thus requiring >3 years to show functional deterioration.”

Nevertheless, a 24-hour average systolic BP ≤130 mm Hg is a reasonable treatment goal, given that intensive treatment of ambulatory BP in older people was well tolerated and accompanied by lower numbers of cardiovascular events, the authors added.

*INtensive versus standard ambulatory blood pressure lowering to prevent functional DeclINe in the ElderlY

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
13 Sep 2020
Regardless of birth weight, being obese at preschool age is associated with a greater risk of elevated blood pressure during early childhood, a recent China study has found. A longer duration of breastfeeding appears to help mitigate such a risk.
Jairia Dela Cruz, 4 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
06 Sep 2020
Type 2 diabetes mellitus patients taking proton pump inhibitors (PPIs) are at a higher risk of sustaining hip fractures, a recent study has found.
6 days ago
Osteoarthritis (OA) is the most common condition affecting the joints. Dr Lee Eu Jin, an Orthopaedic Surgeon from Liberty Orthopaedic Clinic at Mount Elizabeth Medical Centre, Singapore, shares his insights with Pearl Toh on how to manage OA in the primary care setting.