Older people remain on blood pressure agents despite being hypotensive resulting in increased mortality and hospital admission

Morrissey, Yvonne; Bedford, Michael; Irving, Jean; Farmer, Chris

doi:10.1093/ageing/afw120

Cited by 22 publications

(13 citation statements)

References 18 publications

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“…It might be necessary to design a variety of public policies including food reformulation to reduce sodium content and efforts to incentivise primary care providers to give priority to the management of SBP. 28 , 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Abajobir¹,

Abate²,

Abbafati³

et al. 2017

The Lancet

2,072

1,361

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Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. Findings Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9–11·6) decline in deaths and a 10·8% (8·3–13·1) decre...

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Section: Discussionmentioning

confidence: 99%

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Abajobir¹,

Abate²,

Abbafati³

et al. 2017

The Lancet

2,072

1,361

View full text Add to dashboard Cite

show abstract

“…Again, due to the design of this study, it was difficult to say for sure whether the hypotension was the responsible factor or this was due to severe illness which may be the primary reason of mortality, hospitalizations, and poor outcomes. [23]…”

Section: What Is the Threshold To Safely Control Blood Pressure In Thmentioning

confidence: 99%

Hypertension management in the elderly: What is the optimal target blood pressure?

2019

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Hypertension is a common disease in the elderly associated with significant morbidity and mortality. Due to the complexity of this population, the optimal target of blood pressure (BP) control is still controversial. In this article, we conduct a literature review of trials published in English in the last 10 years which were specifically designed to study the efficacy and safety of various BP targets in patients who are 70 years or older. Using these criteria, we found that the benefits in the positive studies were demonstrated even with a minimal BP control (systolic BP [SBP] <150 mmHg) and continued to be reported for a SBP <120 mmHg. On the other hand, keeping SBP <140 mmHg seemed to be safely achieved in elderly patients. Although the safety of lowering SBP to <120 mmHg is debated, Systolic Blood Pressure Intervention Trial study has shown no increased risk of falls, fractures, or kidney failure in elderly patients with SBP lower than this threshold. While the recent guidelines recommended to keep BP <130/80 mmHg in the elderly, more individualized approach should be considered to achieve this goal in order to avoid undesirable complications. Furthermore, further studies are required to evaluate BP target in very old patients or those with multiple comorbidities.

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“…The possible reasons for the lower incidence rate in females at an early age may be due to the positive effects of estrogen on the cerebral circulation. [17,18] In terms of ethnicity, this study showed that the majority of stroke patients were Malay (43.2%) followed by Indians 28.4% and Chinese 28.4%. Another study conducted in Malaysia about the incidence of stroke among Chinese, Malays, and Indians in multiple states shows, the proportion of Malay was much higher than Chinese followed by Indians.…”

Section: Discussionmentioning

confidence: 77%

Untitled

Iqbal¹

2020

AJP

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Objective: This study aimed to evaluate drug utilization pattern among stroke patients. Materials and Methods: A cross-sectional study was conducted among 96 stroke patients aged from 30 to 92 years in a hospital in Malaysia. A total of 88 patients were available for descriptive analysis and logistic regression analysis. Descriptive and logistic regression analyses were performed. Results: On average, patients were aged 67.62 years (standard deviation of 13.14) and had a higher incidence in Malay ethnicity (42.7%). Ischemic stroke accounts for 91.67% of the study, with a slightly higher proportion of female patients (51.04%). Majority of stroke patient complaint generalized body weakness as their major symptom (19.81%). Calcium channel blocker was found to be the most used antihypertensive agent among stroke patients (40.9%) followed by angiotensin-converting enzyme inhibitors (ACEIs) (31.8%). Conclusion: Using logistic regression modeling, it was determined that the factors of a subject would affect the choice of prescribing of ACEIs and anticoagulant drugs.

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Older people remain on blood pressure agents despite being hypotensive resulting in increased mortality and hospital admission

Abstract: the results demonstrate that low SBP is associated with adverse events, it is possible that the pursuit of BP control at a population level may lead to over-treatment in certain groups of patients. This may result in an increased incidence of adverse events particularly in older people.

Cited by 22 publications

References 18 publications

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Hypertension management in the elderly: What is the optimal target blood pressure?

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