Abstract
BackgroundBlood pressure targets for oldest-old people have been long debated due to the concern that more stringent targets are associated with increased mortality. We aimed to investigate the association between changes of late-life systolic blood pressure (SBP), mean SBP and SBP variability (SBPV), and all-cause mortality in oldest-old.MethodsBased on the community-based Chinese Longitudinal Healthy Longevity Survey with follow-up conducted in the 3-year interval, we assembled a retrospective cohort of 6639 participants ≥ 80 years with available blood pressure measurements at baseline and second wave. The primary exposures were mean SBP and SBPV (defined as the annual difference in SBP divided by mean SBP) measured between baseline and second wave. The primary outcome was all-cause mortality assessed from the second wave.ResultsDuring 21443.1 person-years of follow-up, 4622 death was recorded. U-shaped associations of mortality with mean SBP and SBPV were identified; the value of 137 mmHg and 4.0 %/year conferred the minimum mortality risk, respectively. The associations of a larger SBPV with an increased mortality risk were observed for both rises and large falls in SBP. The hazard ratio was 1.11 (comparing lowest versus middle quintile; 95 % CI: 1.01, 1.22) with large falls in SBPV and 1.08 (comparing highest versus middle quintile; 95 % CI: 0.98, 1.18) with large rises in SBPV.ConclusionsU-shaped associations between late-life SBP and SBPV and all-cause mortality were found. Our study suggests that a stable SBP level in the middle range is related to lower mortality risk in the oldest-old.
Highlights
Blood pressure targets for oldest-old people have been long debated due to the concern that more stringent targets are associated with increased mortality
Mean of systolic blood pressure and all-cause mortality The results of the Cox proportional hazards model with penalized splines suggested a U-shaped association between mean SBP and all-cause mortality (Fig. 1)
Compared to participants with mean SBP of 138 ~ 148 mmHg, those among the lowest (< 122 mmHg) or highest (> 148 mmHg) quintile had a higher risk of all-cause mortality, with hazards ratio (HR) 1.18 (95 %confident intervals (CIs): 1.08, 1.29), and 1.18, respectively
Summary
Blood pressure targets for oldest-old people have been long debated due to the concern that more stringent targets are associated with increased mortality. The latest available guidelines for hypertension management in the elderly were mainly based on the same body of evidence but differ significantly in target systolic blood pressure (SBP) values [3, 4]. What’s more, the American Heart Association / American College of Cardiology 2017 Guideline suggests to initiate the antihypertensive therapy for any patient older than 65 years as long as his/her blood pressure higher than 130/80 mmHg [7]. A better understanding of the risks conferred by SBP control is needed to direct clinical decisions and to prevent either excess or inadequate use of antihypertensive treatments in the elderly population [10]
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