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Published on: May 3, 2018
Blood pressure and survival in the oldest old
Daniel J Oates1, Dan R Berlowitz, Mark E Glickman
1Geriatrics Section, Department of Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA. daniel.oates@bmc.org
Objectives:
To determine the relationship between blood pressure (BP) and all-cause mortality in subjects aged 80 and older with hypertension.
Design:
Retrospective cohort study with 5 years of follow-up.
Setting:
Ten Veterans AFFAIRS (VA) sites.
Participants:
Four thousand seventy-one ambulatory patients aged 80 and older with hypertension.
Measurements:
The outcome measure was likelihood of survival during the follow-up period. Vital status was obtained from VA and Social Security files. Variables collected for adjustment in Cox regression models were baseline BP, medications, demographics, diagnoses, and health-related quality of life (HRQoL); HRQoL information was available on 1,289 subjects based on Veterans Health Study Short From-36 (SF-36) questionnaire scores.
Results:
Subjects with higher BP (up to a systolic BP (SBP) of 139 mmHg and a diastolic BP (DBP) of 89 mmHg) were less likely to die during follow-up than subjects with lower BP. After baseline adjustments, the hazard ratio for a 10-point increase in SBP was 0.82 (95% confidence interval (CI)=0.74-0.91), up to a SBP of 139 mmHg, and for DBP was 0.85 (95% CI=0.78-0.92), up to a DBP of 89 mmHg. There was no significant association between survival and BP levels in subjects with uncontrolled hypertension.
Conclusion:
In a cohort of very old, hypertensive veterans, in subjects with controlled BPs, subjects with lower BP levels had a lower 5-year survival than those with higher BPs. This suggests that clinicians should use caution in their approach to BP lowering in this age group.
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Physiological Factors: