Abstract
We studied the relationships between blood pressure (BP), pulse pressure (PP) and cardiovascular (CV) death in older adults using data from 2346 participants enrolled in the Costa Rican CRELES study, mean age 76 years (s.d. 10.2), 31% qualified as wide PP. All covariates included and analyzed were collected prospectively as part of a 4-year home-based follow-up; mortality was tracked for an additional 3 years, identifying 266 CV deaths. Longitudinal data revealed little change over time in systolic BP (SBP), a decline in diastolic BP, and widening of PP. Wide PP was associated with higher risk of CV death but only among individuals receiving antihypertensive drug therapy. Individuals with both wide PP and receiving therapy had 2.6 hazard rate of CV death relative to people with normal-PP plus not taking treatment (TRT), even adjusting for SBP. Increasing PP between visits was significantly associated to higher CV death independently of TRT status. SBP and DBP were not significantly associated to CV death when the effect of PP was controlled for. Conclusion: elderly hypertensive patients with wide or increasing PP, especially if receiving TRT, are the highest CV risk group, thus must be carefully assessed, monitored and treated with caution.
Highlights
Cardiovascular (CV) diseases are the main cause of morbidity and mortality globally with hypertension being responsible for about half of deaths due to heart disease and stroke.[1]
The general objective of this article was to identify the association of high blood pressure (BP) with CV death in a cohort of elderly Costa Ricans from the population-based panel named ‘Costa Rican Longevity and Healthy Aging Study’ or CRELES.[16]
We focused in the association between pulse pressure (PP) and CV death that is independent of the effects of systolic BP (SBP) or diastolic BP (DBP)
Summary
Cardiovascular (CV) diseases are the main cause of morbidity and mortality globally with hypertension being responsible for about half of deaths due to heart disease and stroke.[1]. The role of high BP on CV health among the elderly has been well documented in high-income populations, there is scarce data on the prevalence, management and relative importance of different BP indices on CV risk among elderly from low- and middle-income countries. Several studies suggest that the association between BP and adverse CV events differs across elderly populations from different countries,[8,9,10], but the mechanisms are not well understood. Higher mortality due to competing causes, such as infectious diseases and renal diseases, as well as differences in the prevalence of other CV risk factors could reduce or strengthen the relationship between BP and CV mortality.[11,12]
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