Evidence map›Paper›PMID 41122849›Full record

Trial reportCirculation2025

Heart Stress and Blood Pressure Management in Older Adults: Post Hoc Analysis of the ASPREE Trial.

Anping Cai, Antoni Bayes-Genis, Joanne Ryan, Yingqing Feng, James L Januzzi, Andrew M Tonkin, Jiazhen Zheng, Mark R Nelson, Johannes T Neumann, Robyn L Woods and 11 more

Erratum issuedAbstract readRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Circulation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. A Clinical Prediction Model for Selective NT-proBNP Testing in Hypertension.Journal of clinical hypertension (Greenwich, Conn.) · 2026
    Article
  2. Review
  3. Heart Stress, Frailty and Mortality Risk in two prospective cohorts.medRxiv : the preprint server for health sciences · 2026
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors.

Anping Cai *Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China (A.C., Y.F.).ORCID 0000-0003-3953-5881
Antoni Bayes-Genis *Heart Institute, Hospital Universitari Germans Trias I Pujol, CIBERCV, Badalona, Spain (A.B.-G.).ORCID 0000-0002-3044-197X
Joanne RyanSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.R., A.M.T., J.T.N., R.L.W., C.T., J.J.M., Z.Z.).ORCID 0000-0002-7039-6325
Yingqing FengDepartment of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China (A.C., Y.F.).ORCID 0000-0003-0443-5506
James L JanuzziDepartment of Medicine (Division of Cardiology), Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.L.J.).ORCID 0000-0002-8338-1798
Andrew M TonkinSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.R., A.M.T., J.T.N., R.L.W., C.T., J.J.M., Z.Z.).ORCID 0000-0001-5291-0610
Jiazhen ZhengBioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangdong, China (J. Zheng).ORCID 0000-0003-0163-9175
Mark R NelsonMenzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.R.N.).ORCID 0000-0001-9941-7161
Johannes T NeumannSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.R., A.M.T., J.T.N., R.L.W., C.T., J.J.M., Z.Z.).ORCID 0000-0002-9478-2757
Robyn L WoodsSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.R., A.M.T., J.T.N., R.L.W., C.T., J.J.M., Z.Z.).ORCID 0000-0003-1249-6149
Cammie TranSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.R., A.M.T., J.T.N., R.L.W., C.T., J.J.M., Z.Z.).ORCID 0000-0003-3997-6118
Aletta E SchutteSchool of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia (A.E.S.).ORCID 0000-0001-9217-4937
Ambarish PandeyDepartment of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (A.P.).ORCID 0000-0001-9651-3836
Lin Yee ChenLillehei Heart Institute & Department of Medicine (Cardiovascular Division), University of Minnesota Medical School, Minneapolis (L.Y.C.).ORCID 0000-0002-0700-814X
Lin LiuDepartment of Medicine, School of Clinical Medicine, The University of Hong Kong, China (L.L., H.-F.T.).
Junguo ZhangSchool of Basic Medical Science, Guangzhou University of Chinese Medicine, China (J. Zhang).
John J McNeilSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.R., A.M.T., J.T.N., R.L.W., C.T., J.J.M., Z.Z.).ORCID 0000-0002-1049-5129
Lawrence BeilinMedical School, University of Western Australia, Perth (L.B.).ORCID 0000-0003-4853-7360
Hung-Fat TesDepartment of Medicine, School of Clinical Medicine, The University of Hong Kong, China (L.L., H.-F.T.).ORCID 0000-0002-9578-7808
Gianfranco ParatiDepartment of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.).ORCID 0000-0001-9402-7439
Zhen ZhouSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.R., A.M.T., J.T.N., R.L.W., C.T., J.J.M., Z.Z.).ORCID 0000-0002-0835-8686

Funding

ASPirin in Reducing Events in the ElderlyU01AG029824 · NIA · HENNEPIN HEALTHCARE RESEARCH INSTITUTE · PI MCNEIL, JOHN JAMES, MURRAY, ANNE M · 2009 to 2018
$64.6M
Main Administrative CoreU19AG062682 · NIA · HENNEPIN HEALTHCARE RESEARCH INSTITUTE · PI MURRAY, ANNE M · 2019 to 2023
$42.9M
NIA NIH HHS U01 AG029824NIA NIH HHS U19 AG062682
6 · The paper itself

Abstract

backgroundBlood pressure (BP) management in older adults is complex because of age-related physiological changes and uncertainty around ideal systolic BP (SBP) targets. Heart stress (HS), defined by age-adjusted elevation in NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, may improve cardiovascular disease (CVD) risk stratification and support more individualized BP management.

methodsWe conducted a post hoc analysis of ASPREE (Aspirin in Reducing Events in the Elderly) involving 11 941 community-dwelling older adults without CVD at enrollment (mean age, 75.1 years; 53.5% women). HS was defined by NT-proBNP ≥150 pg/mL for participants 65 to 74 years of age and ≥300 pg/mL for participants ≥75 years of age. Participants were categorized into 4 groups by hypertension and HS status. The primary outcome was total CVD events (a composite of nonfatal myocardial infarction, fatal or nonfatal stroke, coronary heart disease death, or hospitalization for heart failure). Associations between hypertension and SBP with total CVD events were examined by HS status using Cox proportional-hazards models and restricted cubic spline. SBP was evaluated categorically (<120, 120-129, 130-139, 140-159, or ≥160 mm Hg) and continuously. A landmark sensitivity analysis excluded participants with CVD events or censoring in the first 2 years, with follow-up starting at year 3.

resultsHS was present in 25.8% of participants. Compared with the reference group (no hypertension or HS), adjusted hazard ratios (95% CI) for total CVD events were 1.41 (1.18-1.70) for hypertension + no HS, 1.79 (1.34-2.39) for no hypertension + HS, and 2.32 (1.89-2.84) for hypertension + HS (

conclusionsHS is common in older adults and jointly associated with hypertension and increased CVD risk. The SBP-CVD relationship differs by HS status, suggesting a potential value of HS for guiding individualized BP management. Prospective studies are warranted to determine whether HS-guided strategies improve BP control and reduce CVD risk in older adults.

Indexed as

Antihypertensive AgentsAspirinBlood PressureCardiovascular DiseasesHypertensionAgedAged, 80 and overFemaleHumansMaleNatriuretic Peptide, BrainPeptide FragmentsRisk FactorsAntihypertensive AgentsAspirinNatriuretic Peptide, BrainPeptide Fragmentspro-brain natriuretic peptide (1-76)biomarkersblood pressurecardiovascular diseasesrisk

Identifiers

PMID41122849
PMCPMC12616556

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.