Korean J Intern Med.
2022 Sep;37(5):1070-1081. 10.3904/kjim.2022.067.
Optimal blood pressure target in the elderly: rationale and design of the HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial
- Lee DH1
- Lee JH1,2
- Kim SY2
- Lee HY3,4
- Choi JY5
- Hong Y6,7
- Park SK6,7,8
- Ryu DR9
- Yang DH10
- Hwang SJ11
- Choi JH12
- Kim KH13
- Lee SH14
- Joo SJ15
- Park JH16
- Kim SH3,17
- Kim HL3,17
- Kim Ki3,5
- Cho MC
1,2
- Affiliations
-
- 1Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- 2Department of Cardiology and Cardiocerebrovascular Center, Chungbuk National University Hospital, Cheongju, Korea
- 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- 4Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- 5Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- 6Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- 7Cancer Research Institute, Seoul National University, Seoul, Korea
- 8Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
- 9Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
- 10Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- 11Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- 12Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
- 13Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
- 14Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
- 15Department of Cardiology, Jeju National University Hospital, Jeju, Korea
- 16Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- 17Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- KMID: 2533149
- DOI: http://doi.org/10.3904/kjim.2022.067
Abstract
- Background/Aims
The optimal systolic blood pressure (SBP) goal for elderly patients with hypertension, especially to reduce cardiovascular disease (CVD) incidence and improve outcome, is unclear. This study aimed to evaluate the beneficial effects of intensive treatment for hypertension on the incidence of CVD in elderly Korean patients.
Methods
The HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial is a multicenter, parallel-design, open-label, randomized controlled trial designed to evaluate whether intensive treatment (SBP ≤ 130 mmHg) will provide more benefits in lowering the incidence and mortality associated with CVD than standard treatment (SBP ≤ 140 mmHg) in elderly patients with hypertension aged ≥ 65 years. For this study, eleven university hospitals in Korea will enroll approximately 3,176 elderly patients with hypertension between 2019 and 2022. Patients will be requested to visit the clinic every 4 months for the first year and every 6 months thereafter for 36 months. Parameters, including clinic and home blood pressure, anthropometric and laboratory findings, and frailty assessments, will be collected according to the standardized protocol. The primary outcome is a composite of CVD (acute coronary syndrome, stroke, and heart failure) incidence and cardiovascular deaths.
Results
As of December 2021, 1,655 participants had been enrolled in the study, including 831 patients in the standard group and 824 patients in the intensive group.
Conclusions
The HOWOLD-BP trial is the first study performed in Korea to evaluate the beneficial effects of intensive blood pressure treatment on CVD in elderly patients with hypertension. The results of this study will help clarify the appropriate target SBP for this population.
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