Physicians' Academy for Cardiovascular Education

Intensive BP lowering reduces CV events in older patients with hypertension

News - Aug. 30, 2021

STEP Study: intensive vs. standard blood pressure control among older hypertensive patients

Presented at the ESC congress 2021 by: Prof. Jun Cai, MD, PhD - Beijing, China

Introduction and methods

The STEP (Strategy of blood pressure intervention in elderly hypertensive patients) trial aimed to investigate whether intensive blood pressure lowering targeting SBP<130 mmHg could reduce the risk of CV events in older patients with hypertension compared to standard therapy targeting SBP <150 mmHg.

This multi-center, randomized clinical trial enrolled 8511 older patients with hypertension from 42 clinical sites in China. Included patients were aged 60-80 years and had a SBP of 140-190 mmHg during three screening visits or were taking antihypertensive medication. Patients with a history of stroke were excluded. Patients were randomized in a 1:1 ratio to receive intensive treatment (SBP target 110 to<130 mmHg), or standard treatment (SBP target 130 to <150 mmHg). Office BP was measured at follow-up visits at 1, 2, and 3 months and every 3 months thereafter until month 48 or the end of the study. Additionally, all participants received the same validated automatic home BP monitor. Participants could upload readings to a data center using an app. Participants received reminders if BP was not measured regularly and transmitted to the data center. The primary outcome was a composite of stroke, ACS, acute decompensated HF, coronary revascularization, AF or CV death. Secondary outcomes included the components of the primary outcome, all-cause death, MACE, and renal outcomes (decrease in renal function or development of end-stage renal disease). Median follow-up was 3.34 years.

Main results


Intensive blood pressure lowering (SBP target 110 to<130 mmHg) reduced the risk of CV events in older patients with hypertension, compared to standard treatment (SBP target 130 to <150 mmHg).

-Our reporting is based on the information provided at the ESC Congress -

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