Lower blood pressure during antihypertensive treatment is associated with higher all-cause mortality and accelerated cognitive decline in the oldest-old. Data from the Leiden 85-plus Study

Streit, Sven; Poortvliet, Rosalinde K. E.; Gussekloo, Jacobijn

doi:10.1093/ageing/afy072

Cited by 93 publications

(62 citation statements)

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“…Interestingly, in very old frail subjects, several recent observational studies have shown that low SBP levels (SBP <130 mm Hg) were associated with higher morbidity and mortality rates in those receiving BP-lowering drugs but not in those with spontaneously (nondrug-related) BP levels. [73][74][75][76] These observational findings may be because of reverse causality because having BP-lowering medication in old age probably reflects longer hypertension history with its consequences during life-course and, therefore, higher mortality risk than among people without medication. Another interpretation is that the medication-related decrease in BP in these very frail individuals could worsen -not improve -the prognosis.…”

Section: Bp and Reverse Causalitymentioning

confidence: 99%

Hypertension Management in Older and Frail Older Patients

Bénétos

Petrovic

Strandberg

2019

Circulation Research

333

190

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The prevalence of arterial hypertension, particularly systolic hypertension, is constantly rising worldwide. This is mainly the clinical expression of arterial stiffening as a result of the population's aging. Chronic elevation in blood pressure represents a major risk factor not only for cardiovascular morbidity and mortality but also for cognitive decline and loss of autonomy later in life. Clinical evidence obtained in community-dwelling older people with few comorbidities and preserved autonomy supports the beneficial effects of lowering blood pressure in older hypertensive subjects even after the age of 80 years. However, observational studies in frail older individuals treated for hypertension have shown higher morbidity and mortality rates compared with those with lower blood pressure levels. Clearly, in very old subjects, the therapeutic strategy of one size fits all cannot be applied because of the enormous functional heterogeneity in these individuals. Geriatric medicine proposes taking into account the function/frailty/autonomy status of older people. In the present review, we propose to adapt the antihypertensive treatment using an easy-to-apply visual numeric scale allowing the identification of 3 different patient profiles according to the functional status and autonomy for activities of daily living. For the preserved function profile, strategies should be those proposed for younger old adults. For the loss of function/preserved activities of daily living' profile, a more detailed geriatric assessment is needed to define the benefit/risk balance as well as requirements for the tailoring of the various therapeutic strategies. Lastly, for the loss of function and altered activities of daily living' profile, therapeutic strategies should be thoroughly reassessed, including deprescribing (when considered appropriate). In the near future, controlled trials are necessary for the most frail older subjects (ie, in those systematically excluded from previous clinical trials) to gain stronger evidence regarding the benefits of the various therapeutic strategies.

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Section: Bp and Reverse Causalitymentioning

confidence: 99%

Hypertension Management in Older and Frail Older Patients

Bénétos

Petrovic

Strandberg

2019

Circulation Research

333

190

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“…23,24 Based on our earlier study, in which we followed an older cohort over a period of 5 years, we found no evidence that this decline would stop after 1 year or regress to the mean. 17 Our present study builds on a study by Mosello and Simoni 25 but is much larger (1,266 vs 172 participants) and was conducted in a different setting (primary care vs outpatient memory clinics). Mosello and Simoni 25 included only patients with dementia or mild cognitive impairment.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…15,16 In an earlier study, we reported in a population-based Dutch cohort of persons aged 85 years (n = 570) that low SBP was associated with increased all-cause mortality risk and cognitive decline but only in frail patients who were undergoing antihypertensive therapy. 17 In the present study, we set out to determine if low SBP and cognitive decline are similarly associated in a relatively younger cohort of persons aged ≥75 years in the primary care setting and with or without antihypertensive treatment. We also tested for an association between SBP and daily functioning and quality of life (QoL).…”

Section: Introductionmentioning

confidence: 99%

Systolic Blood Pressure and Cognitive Decline in Older Adults With Hypertension

et al. 2019

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PURPOSE Hypertension trials often exclude patients with complex health problems and lack generalizability. We aimed to determine if systolic blood pressure (SBP) in patients undergoing antihypertensive treatment is associated with 1-year changes in cognitive/daily functioning or quality of life (QoL) in persons aged ≥75 years with or without complex health problems. METHODSWe analyzed data from a population-based prospective cohort study (Integrated Systematic Care for Older Persons [ISCOPE]) with a 1-year follow-up. Stratified by SBP level in the year before baseline, we used mixed-effects linear regression models to evaluate the change from baseline to 1-year follow-up in outcome measures (Mini-Mental State Examination [MMSE], Groningen Activity Restriction Scale [GARS], and EQ-5D-3L). We adjusted for age, sex, and baseline MMSE/GARS/EQ-5D-3L scores and stratified for complex health problems as a proxy for frailty.RESULTS Participant (n = 1,266) age averaged 82.4 (SD 5) years, and 874 (69%) were women. For participants undergoing antihypertensive therapy (1,057; 83.5%) and with SBP <130 mm Hg, crude cognitive decline was 0.90 points MMSE, whereas in those with SBP >150 mm Hg, it was 0.14 points MMSE (ie, 0.76-point less decline; P for trend = .013). Complex health problems modified the association of SBP with cognition; the association was seen in those with antihypertensive treatment (P for trend <.001), not in those without (P for trend = .13). Daily functioning/QoL did not differ across the strata of SBP or antihypertensive treatment.CONCLUSIONS Participants aged ≥75 years undergoing antihypertensive treatment, with SBP ≥130 mm Hg compared to <130 mm Hg, showed less cognitive decline after 1 year, without loss of daily functioning or QoL. This effect was strongest in participants with complex health problems. More studies should be conducted to determine if there is a causal relation and to understand the mechanism of the association observed.Annals Journal Club selection; see inside back cover or http://www.Ann FamMed.org/site/AJC/.To read or post commentaries in response to this article, see it online at http://www.AnnFamMed.org/content/17/2/100.

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“…As for the prevention of dementia by antihypertensive therapy, some studies suggest that the risk of dementia is increased by the potential hypotension in antihypertensive therapy due to the impaired vascular regulation mechanism in the elderly [36][37][38] . They did not clarify whether all MCI cases had late-onset hypertension and their follow-up time was too short.…”

Section: Mcip Cannot Benefit From Antihypertensive Therapymentioning

confidence: 99%

Later Onset of Hypertension Is Associated with Higher Risk of Dementia in Mild Cognitive Impairment

Qin

Wang

et al. 2019

Preprint

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ObjectiveTo investigate the correlation between hypertension development and the progression of MCI for middle aged and elderly people. MethodsA population-based longitudinal cognition survey of people aged 55+ was conducted. The hypertension onset age was estimated by self-reported information and medical insurance card records. In order to study the effect of later onset of hypertension on dementia, the incidence of dementia was compared between the two groups. ResultsA total of 277 hypertensive mild cognitive impairment (MCI) participants without dementia were followed for 6 years. Overall, 56 MCI participants (20.22%) progressed to dementia (MCIp). The proportion of MCIp participants in the old-age onset hypertension group (≥ 65 years) was higher than that of middle-age onset one (27.0% vs 15.4%; X2 = 5.538, P = 0.019). And in the old-age onset hypertension group, the proportion of MCIp without diabetes mellitus was higher than those with diabetes mellitus (24.7% vs 12.6%; X2 = 5.321, P = 0.021), and the proportion of MCIp with increased pulse pressure was higher than those without increased pulse pressure (33.3% vs 15.4%; X2 = 3.902, P = 0.048). However, the multivariate logistic regression analysis showed that older age was the only risk for MCIp (OR=0.732, p=0.029). ConclusionsThese results suggest that, individuals with later onset hypertension may have greater cognition decline, even in cases with blood pressure maintained at 130/80 mmHg with antihypertensive management.

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Lower blood pressure during antihypertensive treatment is associated with higher all-cause mortality and accelerated cognitive decline in the oldest-old. Data from the Leiden 85-plus Study

Abstract: lower systolic blood pressure in the oldest-old taking antihypertensives was associated with higher mortality and faster decline in cognitive function.

Cited by 93 publications

References 28 publications

Hypertension Management in Older and Frail Older Patients

Hypertension Management in Older and Frail Older Patients

Systolic Blood Pressure and Cognitive Decline in Older Adults With Hypertension

Later Onset of Hypertension Is Associated with Higher Risk of Dementia in Mild Cognitive Impairment

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