The Systolic Blood Pressure Intervention Trial (SPRINT) included a subset of 2,636 adults aged 75 years and older randomized to a systolic blood pressure (SBP) target of <120 mmHg or to <140 mmHg (1). Of the persons randomized to a SBP <120 mmHg, 33.4% were frail. Of the persons randomized to a SBP <140 mmHg, 28.4% were frail. The primary composite outcome of nonfatal myocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and cardiovascular death was lowered 34% and all-cause mortality lowered 33% by a SBP <120 mmHg (1). These outcomes were not different in frail persons. These very elderly adults with a SBP <120 mmHg also had a 37% lowering of nonfatal heart failure and a 32% lowering of the primary outcome plus all-cause mortality (1). The absolute rate of serious adverse events was 2.4% in the lower SBP treatment group versus 1.4% in the standard SBP treatment group. Orthostatic hypotension occurred in 21.0% in the lower SBP treatment group versus 21.8% in the standard SBP treatment group (1). This study did not include persons living in a nursing home or persons with diabetes, prior stroke, symptomatic heart failure, or a left ventricular ejection fraction (LVEF) <35% (1).
