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Blood pressure experience and risk of cardiovascular disease in the elderly
Insights
High average systolic blood pressure before age 65 independently predicts cardiovascular disease after age 65. Past blood pressure history offers valuable insights for predicting elderly cardiovascular events.
Area of Science:
- Cardiology
- Gerontology
- Epidemiology
Background:
- Cardiovascular disease (CVD) risk assessment in older adults is crucial.
- Predicting incident CVD after age 65 requires understanding long-term risk factors.
Purpose of the Study:
- To evaluate the predictive value of past systolic blood pressure (SBP) history for developing CVD after age 65.
- To determine if historical SBP adds predictive information beyond current SBP measurements.
Main Methods:
- Analysis of 1254 Framingham Heart Study participants aged 65+ without prior CVD or antihypertensive medication use.
- Examined univariate correlates of incident CVD, including SBP at age 65, average pre-65 SBP, and SBP change slope.
- Multivariable regression controlling for SBP at age 65.
Main Results:
- Significant univariate correlates of post-65 CVD included SBP at 65, average pre-65 SBP, and SBP change slope.
- Average pre-65 SBP remained significant (p<0.05) after controlling for SBP at 65.
- Average SBP ≥160 mm Hg before age 65 independently predicted post-65 CVD (rate ratio=1.79).
Conclusions:
- Past systolic blood pressure history, particularly an average ≥160 mm Hg, provides significant incremental value in predicting future cardiovascular disease in the elderly.
- Long-term blood pressure trends are important for assessing cardiovascular risk in later life.
Abstract:
For the 1254 persons in the Framingham Heart Study who survived to age 65 without prior cardiovascular disease or prior use of antihypertensive medications, significant univariate correlates of the development of cardiovascular disease after age 65 included (1) the systolic blood pressure at age 65, (2) the average systolic blood pressure before age 65, and (3) the slope of blood pressure change up to age 65. After controlling for the systolic blood pressure at age 65, average pre-age 65 blood pressure remained significant (p less than 0.05) and the slope of the pre-age 65 blood pressure was marginally significant (p = 0.06). Even after controlling for the mean of up to three blood pressure measurements at age 65, an average systolic blood pressure of 160 mm Hg or greater before age 65 was an independently significant predictor of the post-age 65 development of cardiovascular disease (rate ratio = 1.79; 95% confidence interval = 1.04, 3.07). These data suggest that even after performing multiple measurements at a single examination, knowledge of past systolic blood pressure history, especially if it averages 160 mm Hg or greater, adds a small but statistically significant increment in predicting future cardiovascular disease in the elderly.