Blood Pressure Status and Risk of Cardiovascular Disease in Older Adults Aged 75+ Without Prior Cardiovascular...

This nationwide observational cohort study examined the association between hypertension status and cardiovascular disease (CVD) risk in adults aged ≥75 years without prior CVD events.

Using the Korean National Health Insurance Service (K-NHIS) database, we included individuals aged ≥75 years who underwent health check-ups in 2012-2015. Five statuses of hypertension were defined-normal, pre-hypertension, new-onset hypertension, well-controlled hypertension, and uncontrolled hypertension. The primary outcome was incident CVD (stroke or myocardial infarction). Subdistribution hazard ratios (HRs) were estimated using Fine-Gray models with death as a competing risk. Penalized splines evaluated nonlinear associations of systolic and diastolic blood pressure with outcomes.

Among 869,781 participants (mean age 78.49 ± 3.48 years; 41.7% men), 120,353 (13.8%) developed CVD during a mean follow-up of 6.67 years. Compared with normal, pre-hypertension (HR 1.13; 95% CI 1.11-1.16), new-onset hypertension (HR 1.29; 95% CI 1.26-1.33), controlled hypertension (HR 1.21; 95% CI 1.18-1.23), and uncontrolled hypertension (HR 1.33; 95% CI 1.30-1.36) were all associated with higher CVD risk. Similar associative patterns were observed for stroke and myocardial infarction.

In this large observational cohort, elevated blood pressure (BP) categories were associated with higher risks of stroke and myocardial infarction in adults aged ≥75 years, with the highest risk in uncontrolled hypertension. Stroke risk rose progressively with increasing systolic BP, whereas myocardial infarction demonstrated a U-shaped relationship with diastolic BP. These findings highlight clinically relevant risk patterns in late life and may support future research aimed at optimizing BP assessment in older adults.