title: Hypertension as a risk factor for cardiovascular morbidity and mortality in an elderly German population; the prospective STEPHY II study. Starnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elderly.
abstract: OBJECTIVE
  To prospectively study the relationship between blood pressure levels and subsequent cardiovascular morbidity and mortality in a population aged 65 years and older.
  
  
  METHODS
  Participants of the 1992 baseline survey of the population-based Starnberg Study on Epidemiology of Parkinsonism and Hypertension in the Elderly (STEPHY, 394 men and 588 women above age 65) were followed up for 3 years. Total mortality was assessed by official death data. Cardiovascular morbidity, that is, the occurrence of non-fatal events (new cases of acute myocardial infarction, angina pectoris, stroke, and heart failure) could be assessed in 681 of the 863 survivors by a second interview and analysis of general practitioners' records. The mortality and morbidity risks were compared for hypertensives (baseline blood pressure > or = 160/95 mmHg or antihypertensive treatment) and non-hypertensives.
  
  
  RESULTS
  During follow-up a total of 55 men and 64 women died resulting in a 2.7-year cumulative mortality in this population of 12%. Mortality was higher in men (14%) than in women (11%). Hypertensives had no increased risk of death compared to non-hypertensives (adjusted relative risk (RR)=0. 92; 95% CI: 0.48-1.76 for men and RR=1.36; 95% CI 0.67-2.78 for women). This was confirmed in age-stratified analyses. However, among survivors hypertension was associated with a significantly higher occurrence of non-fatal cardiovascular events. After controlling for potentially confounding baseline conditions, the relative risk for any event (RR=1.44; 95% CI: 1.04-2.0) and, in particular, of acute myocardial infarction (RR=5.5; 95% CI: 1.6-18. 7) was raised among hypertensives. Higher rates for angina pectoris (RR=1.4; 95% CI: 0.9-2.4) and heart failure (RR 1.7; 95% CI: 0.9-2. 9) were of borderline significance. Positive risk associations were confined to the age group 65 to 75 years and not detected at higher ages.
  
  
  CONCLUSIONS
  This study demonstrates for a Central European population older than 65 years the impact of hypertension as a risk factor for cardiovascular and cerebrovascular morbidity. To address the issue that risk of death showed no significant relationship to blood pressure, a longer follow-up period might be necessary.
authors.affiliation: Starnberg Hospital, Ludwig Maximilian University Munich, Starnberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Trenkwalder
authors.forename: P
authors.initials: P
authors.lastname: Hendricks
authors.forename: R
authors.initials: R
authors.lastname: Schöniger
authors.forename: J
authors.initials: J
authors.lastname: Rossberg
authors.forename: H
authors.initials: H
authors.lastname: Lydtin
authors.forename: H W
authors.initials: HW
authors.lastname: Hense
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires; D015996:Survival Rate