Change in Blood Pressure in the Age Interval 70-90. Late Blood Pressure Peak Related to Longer Survival

Lernfelt, Bodil; Svanborg, Alvar

doi:10.1080/08037050213759

Cited by 23 publications

(24 citation statements)

References 29 publications

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“…[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. 8 In general, both diastolic and systolic blood pressure gradually increase up to middle age.…”

Section: Introductionsupporting

confidence: 49%

“…At very old age, however, systolic blood pressure eventually decreases again and it is this decline in systolic blood pressure that is associated with a worse prognosis. 1,10 If low blood pressure at very old age was a reflection of cardiac dysfunction, the increased mortality risk in those with low blood pressure would be easier to understand. To evaluate whether cardiac dysfunction may in part underlie the lower blood pressure in the very old, we performed a comprehensive transthoracic echocardiographic examination in a population-based sample of older people all aged 90 years.…”

Section: Introductionmentioning

confidence: 99%

“…[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%

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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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Section: Introductionsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

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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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“…Different from in middle age, high BP in the elderly has been associated with an increased, equal, or even decreased mortality (22)(23)(24). Within our prospective cohort study, high BP was not related to an increased mortality risk after age 85 yr (25).…”

Section: Discussionmentioning

confidence: 64%

Prospective Study of the Effect of Blood Pressure on Renal Function in Old Age

Bemmel¹,

Woittiez²,

Blauw³

et al. 2006

Journal of the American Society of Nephrology

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High BP is associated with decline of renal function. Whether this is true for very old people largely is unknown. Therefore, this study assessed the effect of BP on creatinine clearance over time in very old participants. A total of 550 inhabitants (34% men) of Leiden, The Netherlands, were enrolled in a population-based study at their 85th birthday and followed until death or age 90. BP was measured twice at baseline and at age 90 yr. Creatinine clearance was estimated annually (Cockcroft-Gault formula). The mean creatinine clearance at baseline was 45.4 ml/min (SD 11.5). Systolic BP was not associated with changes in creatinine clearance during follow-up. Those with diastolic BP (DBP) <70 mmHg had an accelerated decline of creatinine clearance ( In contrast with younger populations, in the oldest individuals, the association among high BP, mortality, and renal function is not straightforward. The available data suggest that BP lowering above 80 yr does not lower overall mortality (4,5). Data on the effect of BP on morbidity such as renal function are relatively scarce in the oldest individuals (6 -8). One longitudinal report associated BP and renal function in a considerable group of very old Japanese individuals (7). In that report, high BP was related to an excess decline of serum creatinine. However, an important drawback was the use of serum creatinine for estimation of renal function. In addition, selection bias could have been induced as a result of exclusion of 40% of the participants, who did not attend the reexamination after 3 yr.Although BP lowering in individuals over 80 yr might not lower mortality, it is unknown whether a high BP might be deleterious for renal function. To investigate whether high BP still is a risk factor for decline in renal function in the oldest individuals, we prospectively studied the effect of BP on changes of creatinine clearance over time in a population-based study of the general population of the oldest individuals. Materials and Methods Study PopulationThe Leiden 85-Plus Study is a prospective, population-based study of all 85-yr-old inhabitants of Leiden, The Netherlands. The study design and characteristics of the cohort were described in detail previously (9,10). In short, between September 1997 and September 1999, all 705 members of the 1912 to 1914 birth cohort in the city of Leiden were asked to participate in the month after their 85th birthday. There were no selection criteria related to health or demographic characteristics. Participants were followed until death or the age of 90. At baseline and yearly thereafter, 85-yr-old participants were visited at their place of residence. During these visits, participants were weighed, BP was measured, a venous blood sample was drawn, an electrocardiogram was recorded, and face-to-face interviews and performance tests were conducted. Information on the medical history was obtained by standardized interviews of the participants' treating physicians. In addition, information on the use of medication was obtained from th...

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“…In the oldest old, blood pressures decrease over time, 6,7 and stronger declines are related to the presence of dementia and cognitive decline. 8,9 One possible explanation for the blood pressure decline in the oldest old might be the increasing prevalence of (subclinical) congestive heart failure.…”

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confidence: 99%

NT-proBNP, blood pressure, and cognitive decline in the oldest old

et al. 2014

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Objective: To study the relation between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, used as a marker of heart failure in clinical practice, blood pressure (BP), and cognitive decline in the oldest old.Methods: In 560 participants of the Leiden 85-plus Study, we measured NT-proBNP levels and BP at age 85 years, at baseline, and global cognitive function (Mini-Mental State Examination [MMSE]) annually during the follow-up of 5 years.Results: Subjects in the highest tertile of NT-proBNP levels scored 1.7 points lower on the MMSE at age 85 years than subjects in the lowest tertile (p 5 0.004), and had a 0.24-point-steeper decline in MMSE score per year (p 5 0.021). The longitudinal association disappeared after full adjustment for possible confounders (0.14-point-steeper decline, p 5 0.187). Subjects in the category "highest tertile of NT-proBNP and the lowest tertile of systolic BP" had a 3.7-point-lower MMSE score at baseline (p , 0.001) and a 0.49-point-steeper decline in MMSE score per year (p , 0.001) compared with subjects in the other categories. Conclusions:In the oldest old, high NT-proBNP levels are associated with lower MMSE scores. The combination of high NT-proBNP levels and low systolic BP is associated with worst global cognitive function and the steepest cognitive decline. Possibly, a failing pump function of the heart results in lower BP and lower brain perfusion with resultant brain dysfunction. Cardiovascular diseases, such as myocardial infarction, generalized atherosclerosis, and stroke have been associated with increased dementia risk and cognitive decline.1-4 Hypertension, however, is only a risk factor for dementia when present in middle age, whereas most studies show that dementia and cognitive decline in the oldest old associate with lower blood pressures. 5In the oldest old, blood pressures decrease over time, 6,7 and stronger declines are related to the presence of dementia and cognitive decline. 8,9 One possible explanation for the blood pressure decline in the oldest old might be the increasing prevalence of (subclinical) congestive heart failure.10 Despite this dynamic correlation between blood pressure and cardiac function in relation to cognitive function in old age, previous studies have mainly focused on either the association of blood pressure or cardiac function with cognitive impairment.Congestive heart failure has been associated with an increased risk of cognitive impairment. 11-13A frequently used serum marker of heart failure is the N-terminal pro-brain natriuretic peptide (NT-proBNP), the inactive fragment of the proBNP hormone. 14 NT-proBNP has proven to be a quantitative marker of acute heart failure in clinical practice, with high sensitivity and reasonable specificity, 15 although elevated NT-proBNP levels are not specific for heart failure in the general population. Several studies have shown that higher NT-proBNP levels associate with lower cognitive function. 16,17 However, the relation among NT-proBNP levels, blood pressure, and cognitive f...

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Change in Blood Pressure in the Age Interval 70-90. Late Blood Pressure Peak Related to Longer Survival

Abstract: Low blood pressure at 70 and late SBP peak were related to longer survival after age 79.

Cited by 23 publications

References 29 publications

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

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

Prospective Study of the Effect of Blood Pressure on Renal Function in Old Age

NT-proBNP, blood pressure, and cognitive decline in the oldest old

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