{"id":"b6791bbb67d3","type":"article","url":"https://hartvaat.nl/2021/09/30/intensieve-bloeddrukcontrole-bij-oudere-patienten-met-hypertensie-nejm-step/","title":"Intensieve bloeddrukcontrole bij oudere patiënten met hypertensie: NEJM STEP","title_en":"Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["ambulante-bloeddrukmeting","bloeddrukbehandeling"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2111437","source_url":"https://doi.org/10.1056/NEJMoa2111437","authors":["Weili Zhang","Shuyuan Zhang","Yue Deng","Shouling Wu","Jie Ren","Gang Sun","Jinfeng Yang","Yinong Jiang","Xinjuan Xu","Tzung-Dau Wang","Youren Chen","Yufeng Li","Lianchen Yao","Dianfang Li","Lixin Wang","Xiaomei Shen","Xinhua Yin","Wei Liu","Xiaoyang Zhou","Bingpo Zhu","Zihong Guo","Hualing Liu","Xiaoping Chen","Yingqing Feng","Gang Tian","Xiuyin Gao","Kazuomi Kario","Jun Cai"],"significance":10,"published":"2021-09-30","source_date":"2021-09-30","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The STEP trial demonstrated that intensive blood pressure control (target 110–130 mmHg) significantly reduced cardiovascular events compared with standard treatment (130–150 mmHg) in Chinese patients aged 60–80 with hypertension. The results confirmed the benefits of intensive blood pressure targets in older adults, extending the findings of SPRINT to an Asian population.","created":"2026-07-03T10:29:23Z","updated":"2026-07-03T18:38:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM STEP trial die intensieve (110-130 mmHg) versus standaard (130-150 mmHg) bloeddrukcontrole vergeleek bij 60-80-jarigen met hypertensie in China. Bevestigt SPRINT bij ouderen.","abstract_original":"BACKGROUND: The appropriate target for systolic blood pressure to reduce cardiovascular risk in older patients with hypertension remains unclear. METHODS: In this multicenter, randomized, controlled trial, we assigned Chinese patients 60 to 80 years of age with hypertension to a systolic blood-pressure target of 110 to less than 130 mm Hg (intensive treatment) or a target of 130 to less than 150 mm Hg (standard treatment). The primary outcome was a composite of stroke, acute coronary syndrome (acute myocardial infarction and hospitalization for unstable angina), acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes. RESULTS: Of the 9624 patients screened for eligibility, 8511 were enrolled in the trial; 4243 were randomly assigned to the intensive-treatment group and 4268 to the standard-treatment group. At 1 year of follow-up, the mean systolic blood pressure was 127.5 mm Hg in the intensive-treatment group and 135.3 mm Hg in the standard-treatment group. During a median follow-up period of 3.34 years, primary-outcome events occurred in 147 patients (3.5%) in the intensive-treatment group, as compared with 196 patients (4.6%) in the standard-treatment group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.92; P = 0.007). The results for most of the individual components of the primary outcome also favored intensive treatment: the hazard ratio for stroke was 0.67 (95% CI, 0.47 to 0.97), acute coronary syndrome 0.67 (95% CI, 0.47 to 0.94), acute decompensated heart failure 0.27 (95% CI, 0.08 to 0.98), coronary revascularization 0.69 (95% CI, 0.40 to 1.18), atrial fibrillation 0.96 (95% CI, 0.55 to 1.68), and death from cardiovascular causes 0.72 (95% CI, 0.39 to 1.32). The results for safety and renal outcomes did not differ significantly between the two groups, except for the incidence of hypotension, which was higher in the intensive-treatment group. CONCLUSIONS: In older patients with hypertension, intensive treatment with a systolic blood-pressure target of 110 to less than 130 mm Hg resulted in a lower incidence of cardiovascular events than standard treatment with a target of 130 to less than 150 mm Hg. (Funded by the Chinese Academy of Medical Sciences and others; STEP ClinicalTrials.gov number, NCT03015311.)."}