Blood pressure and survival in the oldest old.
OBJECTIVE
To determine the relationship between blood pressure (BP) and all-cause mortality in subjects aged 80 and older with hypertension.


METHODS
Retrospective cohort study with 5 years of follow-up.


METHODS
Ten Veterans AFFAIRS (VA) sites.


METHODS
Four thousand seventy-one ambulatory patients aged 80 and older with hypertension.


METHODS
The outcome measure was likelihood of survival during the follow-up period. Vital status was obtained from VA and Social Security files. Variables collected for adjustment in Cox regression models were baseline BP, medications, demographics, diagnoses, and health-related quality of life (HRQoL); HRQoL information was available on 1,289 subjects based on Veterans Health Study Short From-36 (SF-36) questionnaire scores.


RESULTS
Subjects with higher BP (up to a systolic BP (SBP) of 139 mmHg and a diastolic BP (DBP) of 89 mmHg) were less likely to die during follow-up than subjects with lower BP. After baseline adjustments, the hazard ratio for a 10-point increase in SBP was 0.82 (95% confidence interval (CI)=0.74-0.91), up to a SBP of 139 mmHg, and for DBP was 0.85 (95% CI=0.78-0.92), up to a DBP of 89 mmHg. There was no significant association between survival and BP levels in subjects with uncontrolled hypertension.


CONCLUSIONS
In a cohort of very old, hypertensive veterans, in subjects with controlled BPs, subjects with lower BP levels had a lower 5-year survival than those with higher BPs. This suggests that clinicians should use caution in their approach to BP lowering in this age group.
Oates
Daniel J
DJ
Geriatrics Section, Department of Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA. daniel.oates@bmc.org
Berlowitz
Dan R
DR
Glickman
Mark E
ME
Silliman
Rebecca A
RA
Borzecki
Ann M
AM
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006306:Health Surveys; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000401:mortality*; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D011788:Quality of Life; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States; D014493:United States Department of Veterans Affairs