DO MORE, DO NOTHING, OR DO LESS: DECISION-MAKING ABOUT BLOOD PRESSURE CONTROL IN OLDER PATIENTS

Symposia

  • Date:
  • Time: 3:45pm - 4:45pm
  • Track: Clinical Practice
  • CME/CE: 1.0

Sponsored by the Research and the Clinical Practice and Models of Care Committees
Moderator: Mark A. Supiano, MD, AGSF
Despite the profound benefits among older participants in from the Systolic Blood Pressure Intervention Trial (SPRINT), and the new recommended treatment threshold of <130 mm Hg, this more intensive treatment target has not been universally accepted. The goal of this symposium is to discuss some of these potential explanations with a particular focus on the question of generalizability of the SPRINT results to the geriatric patient populations that many AGS members care for. Learning Objectives: (1) discuss how the characteristics of SPRINT participants pertain to the population of older adults, and how the cardiovascular and cognitive benefits in SPRINT translate to the population level; (2) define the older adults with hypertension with a “high degree burden of comorbidity and limited life expectancy” for whom “clinical judgment, patient preference, and a team-based approach to assess risk/benefit is reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs” (ACC/AHA 2017 Hypertension Guideline) should be applied; and (3) review how advanced age (> 80 years), gait speed, frailty status, polypharmacy, and the presence of multiple chronic conditions influences SPRINT treatment outcomes.

Generalizability, Population Health Impact, and Cost-Effectiveness of the SPRINT Results to the US Adult Population
Jordana Cohen, MD, MSCE
Challenges in Translating SPRINT Efficacy into Effectiveness
Ronald I. Shorr, MD, MS
Decision-Making About Blood Pressure Control in Older Patients with Mild to Moderate Functional Decline
Nicholas M. Pajewski, PhD