Rahimi K, Bidel Z, Nazarzadeh M, et al. - There is no indication that relative risk reductions for the prevention of major cardiovascular events change by systolic or diastolic blood pressure levels at randomisation, down to less than 120/70 mmHg, with pharmacological blood pressure-lowering being beneficial into old age. With the removal of age-related blood pressure thresholds from international guidelines, pharmacological blood pressure reduction should be regarded as an important treatment option regardless of age.

• Data were analyzed from 358,707 people who took part in 51 randomized clinical trials.

• The age of candidates at randomization ranged from 21 to 105 years (median 65 years [IQR 59–75]), with 42,960 (12·0%) participants younger than 55 years, 128,437 (35·8%) aged 55–64 years, 128,506 (35·8%) 65–74 years, 54,016 (15·1%) 75–84 years, and 4,788 (1·3%) 85 years and older.

• The hazard ratios for the risk of major cardiovascular events per 5 mmHg decline in systolic blood pressure for each age group were 0·82 in those under the age of 55, 0·91 in those between the ages of 55 and 64, 0·91 in those between the ages of 65 and 74, 0·91 in those between the ages of 75 and 84, and 0·99 in those 85 and older.

• A 3 mmHg reduction in diastolic blood pressure resulted in a similar pattern of proportional risk reductions.

• Absolute risk reductions for major cardiovascular events varied by age, with older groups experiencing greater decreases.

• In any age group, there was no indication of clinically meaningful variation in relative treatment outcomes across different baseline blood pressure categories.