The Long-term Prognostic Significance of Repeated Blood Pressure Measurements in the Elderly

C, Alli; Avanzini, Fausto; Bettelli, G; Colombo, F.; Torri, Valter; Tognoni, Gianni

doi:10.1001/archinte.159.11.1205

Cited by 49 publications

(35 citation statements)

References 49 publications

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“…The most consistent vital sign found to predict adverse clinical events was the systolic blood pressure. This fi nding is consistent with growing evidence from the medical literature that the systolic blood pressure is replacing the diastolic pressure as the most important vital sign in assessing risk of cardiovascular events, [11][12][13][14][15][16][17] especially in an aging population. 12,13 The strength of the association varied among outcome events we modeled, but overall an elevation of 10 mmHg in blood pressure was associated with an increase in risk ranging from 6% for stroke or myocardial infarction (fi rst or recurrent) to 13% for chronic renal insuffi ciency.…”

Section: Risk Of Adverse Events For Hypertensionsupporting

confidence: 87%

“…For example, systolic pressure has been shown to predict myocardial infarctions, strokes, renal insuffi ciency, and sudden death. [11][12][13][14][15][16][17] Diastolic blood pressure correlates with developing ischemic heart disease, 15,[17][18][19][20] sometimes with a J-shaped distribution. 15,20,21 Heart rate predicts cardiovascular death, 22,23 while increased pulse pressure predicts heart failure.…”

Section: Risk Of Adverse Events For Hypertensionmentioning

confidence: 99%

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Quantifying Risk of Adverse Clinical Events With One Set of Vital Signs Among Primary Care Patients with Hypertension

Tierney

Brunt

Kesterson

et al. 2004

The Annals of Family Medicine

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BACKGROUND Hypertension is often uncontrolled. One reason might be physicians' reticence to modify therapy in response to single offi ce measurements of vital signs. METHODSUsing electronic records from an inner-city primary care practice, we extracted information about vital signs, diagnoses, test results, and drug therapy available on the fi rst primary care visit in 1993 for patients with hypertension. We then identifi ed multivariable predictors of subsequent vascular complications in the ensuing 5 years. RESULTSOf 5,825 patients (mean age 57 years) previously treated for hypertension for 5.6 years, 7% developed myocardial infarctions, 17% had strokes, 24% developed ischemic heart disease, 22% had heart failure, 12% developed renal insuffi ciency, and 13% died in 5 years. Controlling for other clinical data, a 10-mmHg increase in systolic blood pressure was associated with 13% increased risk (95% confi dence interval [CI], 6%-21%) of renal insuffi ciency, 9% (95% CI, 3%-15%) increased risk of ischemic heart disease, 7% (95% CI, 3%-11%) increased risk of stroke, and 6% (95% CI, 2%-9%) increased risk of fi rst stroke or myocardial infarction. A 10-mmHg elevation in mean blood pressure predicted a 12% (95% CI, 5%-20%) increased risk of heart failure. An increase in heart rate of 10 beats per minute predicted a 16% (95% CI, 2%-5%) increased risk of death. Diastolic blood pressure predicted only a 13% (95% CI, 4%-23%) increased risk of fi rst stroke.CONCLUSIONS Vital signs-especially systolic blood pressure-recorded routinely during a single primary care visit had signifi cant prognostic value for multiple adverse clinical events among patients treated for hypertension and should not be ignored by clinicians. INTRODUCTIONA dverse cardiovascular events are the leading cause of death in developed nations. Their prevention and treatment consume a large proportion of national health care expenditures. Hypertension, a wellknown modifi able risk factor for adverse cardiovascular events, is among the most common conditions treated in primary care. Yet, hypertension is often inadequately controlled, 1-4 which adds to dramatic costs in terms of dollars and lost years of life as a result of preventable cardiovascular events. 5 One possible reason for inadequate control is physicians' ignoring elevated blood pressure readings. Blood pressure can vary substantially throughout the day, 6,7 and offi ce pressures correlate poorly with and confer less cardiovascular risk than ambulatory blood pressure readings. 8,9 Indeed, guidelines for detecting and treating hypertension require multiple blood pressure elevations, 1 reinforcing the notion that single measurements of blood pressure may not require a physician' s response. William M Tierney, MD 210 RISK OF ADVERSE EVENTS FOR HYPERTENSIONThere is also controversy concerning which vital signs (specifi cally blood pressure and heart rate), or their combinations, were prognostic. For example, systolic pressure has been shown to predict myocardial infarctions, strokes, rena...

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Section: Risk Of Adverse Events For Hypertensionsupporting

confidence: 87%

Section: Risk Of Adverse Events For Hypertensionmentioning

confidence: 99%

Quantifying Risk of Adverse Clinical Events With One Set of Vital Signs Among Primary Care Patients with Hypertension

Tierney

Brunt

Kesterson

et al. 2004

The Annals of Family Medicine

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“…Pekkanen et al 29 studying 1619 men aged 40-59 years at baseline, found that SBP was no longer associated with CAD risk after 20 years of follow-up, when subjects had become elderly, and the Framingham study in a recent re-analysis, 30 concluded that CAD mortality does not depend on SBP in a linearly increasing manner. In the recent analysis of Alli et al, 31 DBP was not an indicator of mortality risk in the elderly. This is also in agreement with previous observations [32][33][34][35][36] suggesting a limited effect of antihypertensive treatment in the prevention of CAD in elderly people.…”

Section: Sbp and Dbp Unpredictive Of Cad Mortalitymentioning

confidence: 88%

Pulse pressure and coronary mortality in elderly men and women from general population

et al. 2002

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The aim of this work was to evaluate whether pulse pressure (PP) in elderly people is a better predictor of coronary mortality than systolic and diastolic blood pressure taken alone. For this aim, 3282 elderly subjects aged у65 years were studied in a population-based frame. Blood pressure was repeatedly measured and averaged; historical data, anthropometrics, blood tests and 14-year coronary mortality were recorded. Statistics included analysis of covariance, Cox analysis and bivariate vectorial analysis. Coronary mortality in women was predicted by PP (1.01 excess risk/mm Hg PP) and was significantly higher in the 3rd than in the 1st tertile of PP (relative risk 2.90); neither systolic nor diastolic pressure taken alone influenced mortality. When systolic and diastolic pressures were both entered into a Cox model, the former had a positive and

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“…The National Health and Nutrition Examination Survey (NHANES II) study by Pastor-Barriuso and the SPAA (Studio sulla Pressione Arteriosa nell'Anziano) Italian BP measurement study 24 both noted a linear, graded, and consistent relationship between systolic pressure and the incidence of CVD events. These studies also failed to note a linear relationship between DBP and CVD events.…”

Section: Discussionmentioning

confidence: 99%

“…While some studies have noted a linear relationship between both systolic and diastolic blood pressure (SBP and DBP) and cardiovascular disease (CVD) event rates in the elderly, 6,7 a linear SBP association and a J-shaped DBP relationship has been noted with CVD events in other studies. 8,9 In the elderly, some disagreement has surrounded the importance of monitoring and treating SBP, DBP, or both, as well as whether to treat isolated and/or borderline isolated systolic hypertension.…”

Section: Introductionmentioning

confidence: 99%

Blood pressure as a predictor of cardiovascular events in the elderly: the William Hale Research Program

2006

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This study evaluates the association between blood pressure (BP) and the risk of developing cardiovascular disease (CVD) events in the elderly. The Morton Plant Mease Foundation has followed 4008 elderly patients 464 years of age for at least 5 years. Systolic and diastolic blood pressure (SBP and DBP) was divided into categories. Cardiovascular disease events were classified as myocardial infarction, stroke, and CVDrelated deaths reported from the National Death Index. Cox proportional hazard ratios were used to assess the relationship between BP and CVD events and controlled for weight, gender, smoker, and alcohol use. Ages o75 and X75 years were assessed separately. After 11.1 years of follow-up, elevated SBP (P ¼ o0.0001) is strongly associated with developing a future CVD event; the relationship is linear and graded and holds for ages above and below 75 years. The frequency of CVD events was lowest in the SBP o120 mm Hg group. In subjects o75 years of age, DBP elevations were not a significant risk factor for CVD events. (relative risk (RR): DBP 70 to o80 mm Hg ¼ 0.92; DBP 80 to o90 mm Hg ¼ 0.88; DBP X90 mm Hg ¼ 1.02.) With subjects X75 years of age, a DBP between 80 and 90 is associated with the lowest significant risk for CVD (RR: DBP 70 to o80 mm Hg ¼ 0.74; DBP 80 to o90 mm Hg ¼ 0.59; DBP X90 ¼ 0.71). In conclusion, these findings support the Joint National Committee on Hypertension recommendations for SBP in the elderly. Further studies are warranted to identify optimal DBP for the elderly at various ages.

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The Long-term Prognostic Significance of Repeated Blood Pressure Measurements in the Elderly

Cited by 49 publications

References 49 publications

Quantifying Risk of Adverse Clinical Events With One Set of Vital Signs Among Primary Care Patients with Hypertension

Quantifying Risk of Adverse Clinical Events With One Set of Vital Signs Among Primary Care Patients with Hypertension

Pulse pressure and coronary mortality in elderly men and women from general population

Blood pressure as a predictor of cardiovascular events in the elderly: the William Hale Research Program

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