HypertensionSecondary analysis
Blood Pressure Trajectories and Cardiovascular Outcomes in Older Patients
- Secondary analysis of the STEP randomised trial
- trajectory analysis
- Fine-Gray subdistribution hazard models
Authors' conclusion
BP control trajectories served as effective predictors of cardiovascular risk. The Rapid-Stable pattern yielded optimal benefits, whereas any deviations-characterized by delayed, unstable, or failed control-significantly elevated risk. The velocity, stability, and quality of control were found to be independent predictors of cardiovascular outcomes.
Study context
- Population
- Older patients with hypertension receiving intensive blood pressure (BP) treatment in the STEP trial (original intensive arm and standard arm transitioned to intensive therapy in the extension)7 trajectories
- Participants
- 7,296 patients
- Comparison
- Systolic blood pressure (SBP) control trajectories during intensive treatment vs Rapid-Stable trajectory
- Primary endpoint
- Composite of CV events
Primary result
As reported in the abstract
- Uncontrolled
- HR ≥2.0
- Labile
- HR 1.83
- Delayed
- HR 1.81-1.89
- Rapid-Unstable
- HR 1.50
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| CV outcomes by continuous dynamic metrics — Each 1-month delay in target achievement · CV risk increased by 3% | 1.03 (1.01–1.04) | |
| 0.512Hazard ratio (log scale) |
| Outcome | HR |
|---|---|
| CV outcomes by continuous dynamic metrics — Higher variability (per SD increase) | 1.13 |
| CV outcomes by continuous dynamic metrics — Higher SBP Load (per SD increase) | 1.21 |
| CV outcomes by continuous dynamic metrics — Time in target range (per 10% increase) · lower time in target range associated with worse outcomes | 0.95 |
- CV outcomes by continuous dynamic metrics: continuous dynamic metrics were independent determinants of CV outcomes
Original publication
Blood Pressure Trajectories and Cardiovascular Outcomes in Older Patients. J Am Coll Cardiol. Published 8 April 2026. doi:10.1016/j.jacc.2026.01.090
Summarised from the published abstract; every number is checked against it