Optimal systolic blood pressure and reduced long-term mortality in older hypertensive women with prior coronary events - An analysis from INVEST☆

Background: Hypertension and coronary artery disease (CAD) are a prevalent combination in older women, however limited data are available to guide blood pressure (BP) management. We hypothesized that older women with hypertension and CAD may not derive long-term benefit by achieving systolic BP (SBP) < 130 mmHg.

Methods: We analyzed long-term all-cause mortality data from the International Verapamil SR/Trandolapril Study (INVEST), stratified by risk attributable to clinical severity of CAD (women with prior coronary events of myocardial infarction or revascularization considered high risk, all others at low risk) and by age group (50-64 or ≥65 years). The prognostic impact of achieving mean in-trial SBP <130 (referent group) was compared with 130-139 and ≥ 140 mmHg using Cox proportional hazards, adjusting for demographic and clinical characteristics.

Results: SBPs <130, 130-139, and ≥140 were achieved in 2960, 3024, and 3232 women, respectively. Among high-risk women aged ≥65 years, those achieving SBP 130-139 mmHg had lower mortality up to 16.7 years later than those with SBP <130 (hazard ratio [HR] 0.81, 95% CI 0.69-0.96). High-risk women aged 50-64 achieving SBP 130-139 had a similar mortality risk as those with SBP <130 (HR 1.21, 95% CI 0.87-1.68), while those achieving SBP ≥140 mmHg had a higher mortality risk than SBP < 130 (HR 1.92, 95% CI 1.37-2.68). A similar pattern was observed among low-risk women ≥65 and <65 years old.

Conclusion: Among women ≥65 years old with hypertension and prior coronary events, in-trial SBP between 130 and 139 mmHg was associated with lower mortality over the long term versus SBP <130 mmHg.