Hypertension: cardiovascular implications in a cohort of old old.
OBJECTIVE
To examine the prevalence and cardiovascular implications of hypertension in advanced age.


METHODS
Prospective non-interventional study of a fixed cohort of very elderly subjects.


METHODS
The subjects were 488 community-dwelling volunteers. Mean age at entry was 79 years (range 75-85). All subjects were ambulatory, non-demented, and free of terminal illness at baseline. Participants were evaluated at the gerontology department of an urban medical school.


METHODS
Cardiovascular morbid and mortal events that were followed included fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, and death. Prevalence of unrecognized myocardial infarction defined by electrocardiographic changes was also assessed.


RESULTS
When hypertension was defined by history, current use of medications, or measured elevations in blood pressure, 78% of the subjects could be considered hypertensive. Univariate analysis showed an increased incidence of strokes in subjects with measured hypertension (P = 0.04). Subjects with elevated blood pressure (untreated) were more likely to develop clinically unrecognized myocardial infarction (P = 0.017). Multivariate survival analysis showed hypertension to be a modest predictor of overall cardiovascular disease (P = 0.067) but not of all-cause mortality. Left ventricular hypertrophy was a predictor of cardiovascular disease (P = 0.013) and all-cause mortality (P = 0.008). Age remained a significant risk factor for these endpoints, even in the very old. Isolated systolic hypertension was analyzed separately and in univariate analysis was a risk factor for stroke but not other cardiovascular morbidity.


CONCLUSIONS
Hypertension at advanced age remains a modestly important risk factor in the development of cardiovascular disease.
Guzik
H J
HJ
Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.
Ooi
W L
WL
Frishman
W H
WH
Greenberg
S
S
Aronson
M K
MK
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006973:Hypertension / Q000145:classification / Q000150:complications* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008487:Medical History Taking; D009519:New York City / Q000453:epidemiology; D011159:Population Surveillance; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
D000959:Antihypertensive Agents