Intensive Blood Pressure Control in Older Adults

To the Editor We read with interest the article by Guo et al that used data from a community-based intervention led by nonphysician health care practitioners in rural China. This clinical trial included 22 386 individuals aged 60 years and older with hypertension. It found that targeting blood pressure below 130/80 mm Hg could sustainably reduce cardiovascular disease incidence by 25% and total mortality by 10%. While these results are promising, we observed that injurious falls, hypotension, and symptomatic hypotension were more frequent in the intervention group compared with usual care. Additionally, hypotension incidence was significantly higher in patients aged 60 years or older and 80 years or older (P < .001). Notably, frailty was not considered in the study’s safety assessment. Given frailty’s impact on blood pressure and adverse health outcomes, its evaluation is essential for effective hypertension management in older adults.