Blood Pressure and Mortality in the Very Old

Rajala, Satu; Haavisto, Matti; Heikinheimo, R; Mattila, Kimmo

doi:10.1016/s0140-6736(83)90554-8

Cited by 33 publications

(22 citation statements)

References 11 publications

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“…Consistent with this, age has been shown to have an impact on associations between several other common conditions and mortality. For example, higher BP is associated with better rather than worse survival in patients who are 80 yr and older, whereas the reverse is true for younger patients (22)(23)(24)(25)(26)(27). A similar phenomenon seems to exist for subclinical hypothyroidism, for which patients who are 80 yr or older and have mildly elevated levels of thyrotropin seem to have a lower risk for death than those with levels in the normal range (28).…”

Section: Discussionmentioning

confidence: 98%

Mortality Risk Stratification in Chronic Kidney Disease

O’Hare

Bertenthal

Covinsky

et al. 2006

Journal of the American Society of Nephrology

316

224

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Current National Kidney Foundation Kidney Disease Outcomes Quality Initiative staging criteria for chronic kidney disease (CKD) are intended to apply to all age groups. However, it is unclear whether different levels of estimated GFR (eGFR) have the same prognostic significance in older and younger patients. The study cohort was composed of Department of Veterans Affairs (VA) patients who were aged 18 to 100 yr and had at least one outpatient serum creatinine measurement between October 1, 2001, and September 30, 2002 (n ‫؍‬ 2583,911). Patients with ESRD were excluded. GFR was estimated using the Modification of Diet in Renal Disease equation using each patient's first outpatient creatinine measurement during the study period. The association of eGFR with survival was measured by age group. Twenty percent of cohort patients had an eGFR <60 ml/min per 1.73 m 2 , ranging from 3% among 18-to 44-yr-olds to as high as 49% among 85-to 100-yr-olds. Fifty-two percent (n ‫؍‬ 266,421) of cohort patients with an eGFR <60 ml/min per 1.73 m 2 had "very" moderate reductions in eGFR into the 50-to 59-ml/min per 1.73 m 2 range. The association of eGFR with mortality was weaker in the elderly than in younger age groups: Whereas severe reductions in eGFR were associated with an increased risk for death in all age groups, "very" moderate reductions in eGFR (50 to 59 ml/min per 1.73 m 2 ) were associated with an increased adjusted risk for death only among patients who were younger than 65 yr. Age-related attenuation of the association of eGFR with mortality was also present among women and black patients. In the clinical setting, mortality risk stratification in elderly patients should not be based on the same eGFR cut points as for younger age groups and would benefit from finer categorization of the 30-to 59-ml/min per 1.73 m 2 eGFR group.

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Section: Discussionmentioning

confidence: 98%

Mortality Risk Stratification in Chronic Kidney Disease

O’Hare

Bertenthal

Covinsky

et al. 2006

Journal of the American Society of Nephrology

316

224

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“…However, consistent with this, differences across age groups in the prognostic importance of blood pressure measurements have been documented previously. [23][24][25][26][27][28] Possible mechanisms for alterations in the prognostic importance of AAI with advancing age include a higher prevalence of other comorbidities at older ages (lessening the potential impact of a single condition on mortality) and the presence of a survival advantage among elderly patients with AAI measurements ordinarily associated with higher mortality risk.…”

Section: Discussionmentioning

confidence: 99%

Mortality and Cardiovascular Risk Across the Ankle-Arm Index Spectrum

et al. 2006

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Background-A low ankle-arm index (AAI) is a strong predictor of mortality and cardiovascular events. A high AAI also appears to be associated with higher mortality risk in select populations. However, mortality and cardiovascular risk across the AAI spectrum have not been described in a more broadly defined population. Methods and Results-We examined total and cardiovascular mortality and cardiovascular events across the AAI spectrum among 5748 participants in the Cardiovascular Health Study (CHS). The mean age of the sample population was 73Ϯ6 years, and the sample included 3289 women (57%) and 883 blacks (15%). The median duration of follow-up was 11.1 (0.1 to 12) years for mortality and 9.6 (0.1 to 12.1) years for cardiovascular events. There were 2311 deaths (953 of which were cardiovascular) and 1491 cardiovascular events during follow-up. For cardiovascular events, risk was higher at all AAI levels Ͻ1 but not for AAI levels Ͼ1.4 (HR 1.00, 95% CI 0.57 to 1.74). The association of a high AAI with mortality was stronger in men than in women and in younger than in older cohort members. Conclusions-In a cohort of community-dwelling elders, mortality risk was higher than the referent category of 1.11 to 1.2 among participants with AAI values above the traditional cutpoint of 0.9 (ie, 0.91 to 1.0 and Ͼ1.4), and the specific association of AAI with mortality varied by age and gender. (Circulation. 2006;113:388-393.)

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“…[1][2][3][4][5][6] Some of the studies have shown the expected correlation between high blood pressure and increased mortality risk. 6 Some, however, did not find these associations.…”

Section: Introductionmentioning

confidence: 99%

“…6 Some, however, did not find these associations. [2][3][4] Moreover, others reported the mortality risk to be higher in those with a relatively low blood pressure. 1,5,7 In line with these unexpected findings, we have recently shown low blood pressure to be associated with organ failure, for example loss of renal function.…”

Section: Introductionmentioning

confidence: 99%

Low blood pressure in the very old, a consequence of imminent heart failure: the Leiden 85-plus Study

et al. 2008

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Low blood pressure in the very old has been associated with organ dysfunction and excess mortality but the underlying mechanism has yet to be elucidated. We hypothesized that cardiac dysfunction contributes to low blood pressure in the very old. We invited a convenience sample consisting of 82 participants all aged 90 years from a population-based cohort study in the very old. Blood pressure was measured twice, and all but one underwent echocardiography to assess cardiac dimensions and functional cardiac parameters. Some 47 participants were free from haemodynamically significant valvular disease and were included in the present analyses.

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Blood Pressure and Mortality in the Very Old

Cited by 33 publications

References 11 publications

Mortality Risk Stratification in Chronic Kidney Disease

Mortality Risk Stratification in Chronic Kidney Disease

Mortality and Cardiovascular Risk Across the Ankle-Arm Index Spectrum

Low blood pressure in the very old, a consequence of imminent heart failure: the Leiden 85-plus Study

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