Association Between Blood Pressure and Survival over 9 Years in a General Population Aged 85 and Older

Rastas, Sari; Pirttilä, Tuula; Viramo, Petteri; Verkkoniemi, Auli; Halonen, Pirjo; Juva, Kati; Niinistö, Leena; Mattila, Kimmo; Länsimies, Esko; Sulkava, Raimo

doi:10.1111/j.1532-5415.2006.00742.x

Cited by 129 publications

(109 citation statements)

References 37 publications

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“…Some indicate linearly worse outcomes with higher BP (4), whereas others suggest that BP has a J-shaped association with outcomes (5)(6)(7)(8) and that high BP has a diminished or reversed association with adverse outcomes in elderly patients. Clinical trials offer some indication that treating elevated BP to moderately low levels may decrease cardiovascular events in very old individuals (9,10), but it remains unclear whether using even stricter targets is beneficial (11,12).…”

Section: Introductionmentioning

confidence: 99%

Age and Outcomes Associated with BP in Patients with Incident CKD

Kövesdy

Al‐Rifai

Gosmanova

et al. 2016

CJASN

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Background and objectives Hypertension is the most important treatable risk factor for cardiovascular outcomes. Many patients with CKD are elderly, but the ideal BP in these individuals is unknown.Design, setting, participants, & measurements From among 339,887 patients with incident eGFR,60 ml/min per 1.73 m 2 , we examined associations of systolic BP (SBP) and diastolic BP (DBP) with all-cause mortality, incident coronary heart disease (CHD), ischemic strokes, and ESRD from the time of developing CKD until the end of follow-up (July 26, 2013, for mortality, CHD, and stroke, and December 31, 2011, for ESRD) in multivariableadjusted survival models categorized by patients' age.Results Of the total cohort, 300,424 (88%) had complete data for multivariable analysis. Both SBP and DBP showed a U-shaped association with mortality. SBP displayed a linear association with CHD, stroke, and ESRD, whereas DBP showed no consistent association with either. SBP.140 mmHg was associated with higher incidence of all examined outcomes, but with an incremental attenuation of the observed risk in older compared with younger patients (P,0.05 for interaction) The adjusted hazard ratios and 95% confidence intervals associated with SBP$170 mmHg (compared with 130-139 mmHg) in patients ,50, 50-59, 60-69, 70-79, and $80 years were 1.95 (1.34 to 2.84), 2.01 (1.75 to 2.30), 1.68 (1.49 to 1.89), 1.39 (1.25 to 1.54), and 1.30 (1.17 to 1.44), respectively. The risk of incident CHD, stroke, and ESRD was incrementally higher with higher SBP in patients aged ,80 years but showed no consistent association in those aged $80 years (P,0.05 for interaction for all outcomes). ConclusionsIn veterans with incident CKD, SBP showed different associations in older versus younger patients. The association of higher SBP with adverse outcomes was present but markedly reduced in older individuals, especially in those aged $80 years. Elevated DBP showed no consistent association with vascular outcomes in patients with incident CKD.

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Section: Introductionmentioning

confidence: 99%

Age and Outcomes Associated with BP in Patients with Incident CKD

Kövesdy

Al‐Rifai

Gosmanova

et al. 2016

CJASN

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“…[16][17][18] Taking into account that some epidemiological studies have suggested that BP is inversely related to the risk of death in patients 80 years or older, there is very scarce information about the best practices in the elderly population. 4,19,20 However, recent clinical trials such as HYVET 12 provide consistent evidence that antihypertensive treatment in persons 80 years of age or older is beneficial. In this context, surveys such as PRESCAP 2006 are important because they depict clinical practice and provide an accurate picture of the hypertensive population 80 years of age or older who are managed in primary care.…”

Section: Discussionmentioning

confidence: 99%

“…Although the prevalence of hypertension increases with age (about three-quarters of patients 80 years or older are hypertensives), the available evidence about the benefits of treating hypertension in that patient population is scarce. 4,5 Most randomized controlled trials involving older adults either have excluded those 80 years or older or have included too few participants. [6][7][8][9] Systolic blood pressure (BP) increases with age, whereas diastolic pressure rises until the 50 s and falls after that.…”

Section: Introductionmentioning

confidence: 99%

Blood pressure control and physicians’ therapeutic behavior in a very elderly Spanish hypertensive population

Rodríguez-Roca¹,

Pallarés-Carratalá²,

Alonso-Moreno³

et al. 2009

Hypertens Res

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This study sought to assess blood pressure (BP) control rates by determining the factors associated with poor BP control, therapeutic management and physicians' therapeutic behavior among elderly Spanish hypertensive patients in a primary care setting. This cross-sectional multicenter study included hypertensive patients at least 80 years of age in primary care settings throughout Spain who were on pharmacologic treatment. BP was considered well controlled at o140/90 mm Hg (o130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). A total of 923 patients were included (83.3±3.5 years; 62.9% women). Almost two-thirds (64.0%) of the patients were taking a combined therapy (68.7%; 2 drugs) and approximately one-third (35.6%; 95% CI 32.6-38.7) of the patients attained BP goals. Physicians modified the antihypertensive treatment in 26.1% (95% CI 22.3-29.9) of patients with uncontrolled BP, which most frequently involved the addition of another drug (47.6%). Predictive factors for no BP control and no therapeutic modification in patients with uncontrolled BP included diabetes (OR 2.8 (95% CI 2.0-3.9); Po0.0001) and mistaken physician perceptions about BP control (OR 108.1 (95% CI 40.5-288.6); Po0.0001), respectively. Only three out of 10 hypertensive patients 80 years or older in Spain achieved the BP goals. Physicians only modified the treatment in one out of four patients with uncontrolled BP. Diabetes was associated with a threefold increase in the likelihood of uncontrolled BP, and the mistaken physician perceptions about BP control were associated with a 100-fold rise in the probability of not modifying antihypertensive therapy.

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“…Аналогичные результаты были получены и в ряде об-сервационных исследований [25][26][27]. В частности, в ис-…”

Section: эффективность антигипертензивной терапии у пациентов старше unclassified

Pharmacotherapy of Arterial Hypertension in Elderly Patients: Focus on Octogenarians

Ушкалова

Ткачева²,

Рунихина³

et al. 2016

Racionalʹnaâ farmakoterapiâ v kardiologii

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Артериальная гипертензия (АГ) ежегодно является причиной более 7 млн. преждевременных смертей и занимает 4,5% в глобальной структуре бремени за-болевания (преждевременная смерть+инвалидиза-ция) [1]. Распространенность АГ повышается с возрас-том -по данным исследования National Health and Nutrition Examination Survey она составляет у мужчин в воз-расте 45-54 лет 36,8%, у женщин -32,7%, старше 75 лет -76,4 и 79,9%, соответственно [2]. В связи с по-старением населения и ростом распространенности АГ прогнозируется, что к 2030 г. осложнения заболевания станут причиной четверти всех смертей в мире [3]. При этом фармакотерапия больных старшего возраста ос-новывается преимущественно на консенсусных, а не до-казательных данных, так как эти пациенты обычно не включаются в рандомизированные клинические ис-следования (РКИ). Особенности артериальной гипертензии и ее фармакотерапии у пожилых пациентовЛечение больных пожилого возраста осложняется целым рядом взаимосвязанных проблем, представ-ленных на рис. 1.К числу основных особенностей АГ у лиц пожило-го возраста относится превалирование изолированной систолической артериальной гипертонии (ИСАГ), ас-социирующейся с высоким риском развития сердечно-сосудистых осложнений. Ее доля среди лиц в возрас-те >60 лет составляет 65%, а >70 лет -90% [5]. По дан-ным мета-анализа, повышение систолического арте-риального давления (САД) на каждые 20 мм рт.ст. ас-социируется с удвоением смертности от ишемической болезни сердца и инсульта, причем абсолютный риск кардиоваскулярной смертности при равном повыше-нии САД у пожилых пациентов достоверно превыша-ет таковой у лиц моложе 50 лет [6] Pharmacotherapy of arterial hypertension in the elderly is discussed. Russian and international guidelines are presented with a focus on target levels of blood pressure and drugs of choice in these patients. Issues of efficacy and safety of antihypertensive therapy in patients aged 80 years and older are considered.

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Association Between Blood Pressure and Survival over 9 Years in a General Population Aged 85 and Older

Abstract: Low systolic BP may be partially related to poor general health and poor vitality, but the very old may represent a select group of individuals, and the use of BP-lowering medications needs to be evaluated in this group.

Cited by 129 publications

References 37 publications

Age and Outcomes Associated with BP in Patients with Incident CKD

Age and Outcomes Associated with BP in Patients with Incident CKD

Blood pressure control and physicians’ therapeutic behavior in a very elderly Spanish hypertensive population

Pharmacotherapy of Arterial Hypertension in Elderly Patients: Focus on Octogenarians

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