Intensive BP lowering reduces CV events in older patients with hypertension

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

• The average SBP reached during follow-up was 126.7 mmHg in the intensive treatment group and 135.9 mmHg in the standard treatment group. This translates to a between-group difference of 9.2 mmHg.
• During follow-up, a primary outcome event occurred in 4.6% of patients in the standard treatment group and in 3.5% of patients in the intensive treatment group, with a relative risk reduction of 26% (HR 0.74, 95%CI 0.60-0.92, P=0.007).
• Compared to standard treatment, intensive treatment was associated with a lower relative risk of stroke (HR 0.67, 95%CI 0.47-0.97), ACS (HR 0.67, 95%CI 0.47-0.94) and HF (HR 0.27, 95%CI 0.08-0.98).
• There were no differences in risk of coronary revascularization, AF and all-cause mortality between groups.
• Incidence of safety outcomes and renal outcomes did not differ between groups except for hypotension, which occurred in 3.4% of patients in the intensive treatment group and in 2.6% of patients in the standard treatment groups (P=0.03).

Conclusion

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 -