title: Low midlife blood pressure, survival, comorbidity, and health-related quality of life in old age: the Helsinki Businessmen Study.
abstract: OBJECTIVE
  The aim of the present study was to examine the long-term impact of midlife blood pressure (BP) on mortality, comorbidity, and health-related quality of life (HRQoL) in old age.
  
  
  METHODS
  These are longitudinal analyses of the Helsinki Businessmen Study, a cohort of business executives, born in 1919-1934, whose BP was measured between 1964 and 1973 (n = 3267). Comorbidity and HRQoL with RAND-36 [Short Form (SF)-36] were assessed from questionnaires in 2000; mortality up to 31 July 2012 was ascertained from national registers. Baseline BP was categorized as normal, less than 120  mmHg systolic and less than 80  mmHg diastolic (n = 121); prehypertension, 120-139  mmHg systolic or 80-89  mmHg diastolic (n = 2131); stage 1 hypertension, 140-159 mmHg systolic or 90-99  mmHg diastolic (n = 757); and stage 2 hypertension, more than 160  mmHg systolic or more than 100  mmHg diastolic (n = 258). Main outcome measures were long-term mortality, comorbidity, and HRQoL in old age.
  
  
  RESULTS
  During the 48-year follow-up, 2013 men (61.6%) died. There was a graded relationship between BP and total mortality (P < 0.001). The men with normal BP had the lowest mortality; the age-adjusted difference in mean survival was 7.5 years between the normal and stage 2 baseline BP groups, and 11.2 months between normal and prehypertension groups. Lower BP in midlife was associated with better scores in the physical functioning (P-linear trend <0.001) and general health (P = 0.01) scales of RAND-36 in old age. RAND-36 scales associated with mental health were not affected by midlife BP.
  
  
  CONCLUSIONS
  Lower BP in midlife is associated with longer life and better physical HRQoL in old age.
authors.affiliation: aDepartment of Medicine, Geriatric Clinic, University of Helsinki, and Helsinki University Central Hospital bInstitute of Health Sciences/Geriatrics, University of Oulu, and Oulu University Hospital, Oulu cDepartment of Public Health, University of Turku, Turku dTHL-National Institute for Health and Welfare eUnit of General Practice, Helsinki University Central Hospital fDepartment of General Practice, University of Helsinki, Helsinki, Finland.
authors.forename: Arto Y
authors.initials: AY
authors.lastname: Strandberg
authors.forename: Timo E
authors.initials: TE
authors.lastname: Strandberg
authors.forename: Sari
authors.initials: S
authors.lastname: Stenholm
authors.forename: Veikko V
authors.initials: VV
authors.lastname: Salomaa
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkälä
authors.forename: Reijo S
authors.initials: RS
authors.lastname: Tilvis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D015897:Comorbidity; D003971:Diastole; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000503:physiopathology; D007022:Hypotension / Q000401:mortality* / Q000503:physiopathology; D008136:Longevity; D008297:Male; D008875:Middle Aged; D058246:Prehypertension / Q000401:mortality; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013599:Systole