Stroke risk reduction associated with strict blood pressure control in patients aged ≥80 years who underwent catheter revascularization
T Fujiwara, T Kabutoya, T Kohro, Y Imai, K Kario, H Fujita, N Akashi, M Nakayama, A Kiyosue, Y Mizuno, Y Miyamoto, K Tsujita, T Matoba, R NagaiAbstract
Background
Blood pressure (BP) control is a cornerstone of secondary prevention in patients with coronary artery disease who underwent catheter revascularization. However, evidence supporting strict BP targets in very elderly patients, particularly those aged ≥80 years, remains limited.
Purpose
We investigated whether achieving a BP target of <130/80 mmHg, as recommended by major hypertension guidelines, is associated with reduced stroke risk in patients who underwent catheter revascularization, and whether the magnitude of benefit differs between patients aged ≥80 years and those aged <80 years.
Methods
We analysed data from the Clinical Deep Data Accumulation System (CLIDAS), a multicentred Japanese registry including 8,793 patients who underwent percutaneous coronary intervention (mean age 70.1±11.1 years; 77.9% male). Patients were stratified by age (≥80 vs. <80 years) and by BP level at hospital discharge (<130/80 vs. ≥130/80 mmHg). The primary outcome was the first occurrence of fatal or nonfatal stroke. Given the high mortality rate among very elderly patients, non-stroke death was treated as a competing risk, and hazard ratios (HRs) were estimated using Fine–Gray models. Absolute risk reductions (ARRs) in 3-year stroke risk were additionally calculated to assess clinical relevance.
Results
Among the study population, 1,731 patients (19.7%) were aged ≥80 years (mean age 83.9±3.3 years; 65.2% male), and 7,062 patients (80.3%) were aged <80 years (mean age 66.7 years; 81.0% male). During a median follow-up of 2.6 years (24,665 person-years), 311 stroke events (3.5%) were observed. In patients aged <80 years, BP <130/80 mmHg was not significantly associated with stroke risk reduction (HR 0.92, 95% confidence interval [CI] 0.57 to 1.47). In contrast, among patients aged ≥80 years, BP <130/80 mmHg was associated with a substantially lower risk of stroke (HR 0.34, 95% CI 0.17 to 0.68). Correspondingly, achieving BP <130/80 mmHg was associated with an absolute reduction in 3-year stroke risk of 3.01% (95% CI 0.85% to 5.44%; number needed to treat [NNT] 33.3) in patients aged ≥80 years, whereas the ARR in patients aged <80 years was 0.69% (95% CI −0.03% to 1.37%; NNT 144.3).
Conclusions
In patients who underwent catheter revascularization, BP control to <130/80 mmHg was associated with a greater reduction in stroke risk among patients aged ≥80 years compared to those aged <80 years. Given the high baseline risk and limited life expectancy in very elderly individuals, this magnitude of absolute stroke risk reduction may be considered clinically meaningful, supporting the potential benefit of strict BP control even in advanced age.