Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension

This multicenter randomized trial (STEP) evaluated whether intensive systolic blood pressure control (target 110 to <130 mm Hg) offers cardiovascular benefit over standard control (130 to <150 mm Hg) in Chinese adults aged 60–80 with hypertension. Among 8511 participants followed for a median of 3.34 years, the intensive group had a significantly lower incidence of composite cardiovascular outcomes (3.5% vs. 4.6%; hazard ratio 0.74; P=0.007), including stroke, acute coronary syndrome, and heart failure. Most secondary outcomes favored intensive therapy. Renal outcomes and adverse events (e.g. dizziness, syncope) were similar between groups, although hypotension was more common with intensive control. Home and office BP readings remained significantly lower throughout the study in the intensive group. The trial supports lowering systolic BP below 130 mm Hg for older hypertensive patients in China.

This multicenter randomized trial (STEP) evaluated whether intensive systolic blood pressure control (target 110 to <130 mm Hg) offers cardiovascular benefit over standard control (130 to <150 mm Hg) in Chinese adults aged 60–80 with hypertension. Among 8511 participants followed for a median of 3.34 years, the intensive group had a significantly lower incidence of composite cardiovascular outcomes (3.5% vs. 4.6%; hazard ratio 0.74; P=0.007), including stroke, acute coronary syndrome, and heart failure. Most secondary outcomes favored intensive therapy. Renal outcomes and adverse events (e.g. dizziness, syncope) were similar between groups, although hypotension was more common with intensive control. Home and office BP readings remained significantly lower throughout the study in the intensive group. The trial supports lowering systolic BP below 130 mm Hg for older hypertensive patients in China.