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The predictive ability of blood pressure in elderly trial patients

Matthew J Carr1, Yanchun Bao, Jianxin Pan

  • 1Biostatistics, Health Methodology Research Group, University of Manchester, Manchester, UK. matthew.carr@manchester.ac.uk

Journal of Hypertension
|August 9, 2012
PubMed

Insights

Blood pressure variability and diastolic pressure significantly impact stroke risk, beyond just systolic pressure. These factors, along with historical measurements, can improve cardiovascular risk assessment in older adults.

Area of Science:

  • Cardiology
  • Gerontology
  • Public Health

Background:

  • Cardiovascular disease remains a leading cause of mortality in elderly populations.
  • Understanding the multifaceted nature of blood pressure (BP) is crucial for effective risk stratification.
  • Previous studies primarily focused on mean systolic blood pressure (SBP), potentially overlooking other critical BP parameters.

Purpose of the Study:

  • To evaluate the influence of the complete blood pressure (BP) profile on cardiovascular risk in elderly hypertensive patients.
  • To determine if the benefits of antihypertensive medications are solely attributable to reductions in SBP.
  • To explore the prognostic value of BP variability and diastolic pressure (DBP) in predicting stroke and coronary heart disease (CHD).

Main Methods:

  • Longitudinal BP data from 4396 hypertensive patients were analyzed using multilevel and time-to-event models.
  • The study assessed the association of BP parameters (mean, variability, historical values) with stroke and CHD events.
  • Outcomes were compared across diuretic, beta-blocker, and placebo treatment arms.

Main Results:

  • BP variability and current DBP independently predicted stroke risk, with risk ratios of 1.15 and 1.43, respectively.
  • Current SBP also significantly predicted stroke (risk ratio 1.36).
  • For CHD risk, only the highest SBP measurement and SBP variability showed significant associations (risk ratios 1.26 and 1.16).

Conclusions:

  • Individual cardiovascular risk assessment can be enhanced by incorporating measures of BP variability and DBP, in addition to current SBP.
  • Temporal BP fluctuations provide prognostic information beyond average BP levels.
  • These findings suggest a more comprehensive approach to managing hypertension in the elderly is warranted.
Abstract

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