Abstract Body (Do not enter title and authors here): Introduction: Blood pressure targets for the elderly are still controversial, there is a lack of certainty about the benefit and safety of targeting ≤ 130mmHg systolic blood pressure. Evaluate the benefit in important cardiovascular outcomes and safety in elderly patients of a blood pressure control ≤ 130mmHg compared to standard of care.

Methods: The research was performed in PubMed, EMBASE, Scielo, LILACS, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1st, 2013 to May 1st, 2023. Randomized controlled trials that were published between January 1st, 2013 and May 1st, 2023 that included hypertensive patients over 60 years old which reported major adverse cardiovascular outcomes (MACE) or all-cause mortality, cardiovascular mortality and safety outcomes were selected. The data extraction was performed independently by two investigators following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A meta-analysis was performed using a fixed-effect model. The results were reported as the pooled results using risk ratio (RR) and a confidence interval (CI) of 95%.

Results: The 4 trials included a number of 16,834 patients, the mean age was over 65 years, there was a good balance between genders, 13.3% of patients had cardiovascular disease, 10.9% diabetes, and 15.5% chronic kidney disease. The mean achieved blood pressure was roughly under 130mmHg, only one study was over (135mmHg) and the mean follow-up time was over 32 months. The intensive therapy decreased the outcomes for mortality (RR = 0.75, 95% CI 0.64 – 0.87, p <0.001), cardiovascular outcomes (RR = 0.72, 95% CI 0.63 – 0.82, p<0.001), and stroke (RR = 0.71, 95% CI 0.57 – 0.89, p =0.004) and proved to be safe. The heterogeneity was moderate for the first two outcomes (I2 =51%, p = 0.10 and I2= 43%, p = 0.15) and low for stroke (I2 = 0%, p = 0.70). For severe safety outcomes (RR = 0.90, 95 % CI 0.71 – 1.15, p = 0.40) and general safety outcomes (RR = 1.05, 95% CI 1.00 – 1.11, p = 0.05) there was no difference with low heterogeneity (I2 = 0%, p = 0.40 and I2 = 0%, p = 0.44). In the sub-analysis of patients over 70 years old, there was a lower incidence of the composite outcome (RR = 0.66, 95% CI,0.54 – 0.78, p < 0.001) with a high heterogeneity (I2 = 65%, p = 0.04).

Conclusions and Relevance: Aiming for a systolic blood pressure ≤ 130mmHg in the elderly appears to be more efficacious than the standard therapy and is safe.