Prognosis Estimates Based on SBP in Geriatric Patients With Hypertension
Primary care patients >80 years old treated to achieve SBP <150 mm Hg were observed to have greater mortality than those with target SBP <135 mmHg over 11.9 years of follow-up.
HealthDay News – For adults aged 80 years and older without comorbidity, systolic blood pressure (SBP) <135 mm Hg is associated with greater mortality, according to a study published in the Journal of the American Geriatrics Society.
João Delgado, PhD, from the University of Exeter Medical School in the United Kingdom, and colleagues conducted a cohort analysis among individuals (aged 80 years and older) who were taking antihypertensive medications, and were free of dementia, cancer, coronary heart disease, stroke, heart failure, and end-stage renal failure at baseline. The authors grouped SBP in 10-mm Hg increments from <125 mm Hg to ≥185 mm Hg.
The researchers observed a linear increase in the risk of myocardial infarction with increasing SBP. The risk of stroke increased for SBP of ≥145 mm Hg, while mortality was lowest among those with SBP of 135 to 154 mm Hg. For the 13.1% of participants with SBP <135 mm Hg, mortality was significantly higher than that seen in the reference group (hazard ratio, 1.25, equivalent to one extra death per 12.6 participants).
This difference was consistent over short- and long-term follow-up and persisted after adjustment for diastolic BP.
"More work is needed to establish whether unplanned SBPs less than 135 mm Hg in older adults with hypertension may be a useful clinical sign of poor prognosis, perhaps requiring clinical review of overall care," the authors write.
One author disclosed financial ties to the pharmaceutical industry.
Delgado J, Masoli JA, Bowman K, et al. Outcomes of treated hypertension at age 80 and older: Cohort analysis of 79,376 individuals. [Published online December 30, 2016]. J Am Geriatr Soc. doi: 10.1111/jgs.14712