title: Low systolic blood pressure and mortality from all-cause and vascular diseases among the rural elderly in Korea; Kangwha cohort study.
abstract: The association between low systolic blood pressure (SBP) and vascular diseases is unclear. The aim of this study was to prospectively examine the association between SBP, especially low SBP, and mortality from all causes and vascular diseases among the elderly in Korea. Six thousand two hundred ninety four residents in a rural community were followed-up for deaths from 1985 to 2008. The adjusted hazard ratios (aHR) and 95% confidence intervals were calculated by Cox proportional hazard model. A stratified analysis was conducted by age at enrollment. Among the elderly aged 65 and above, the lowest SBP (<100 mm Hg) group had an elevated aHR for mortality from vascular diseases (aHR = 2.1, 95% CI = 1.2-3.9) including stroke (aHR = 2.4, 95% CI = 0.9-6.3) and ischemic heart diseases (aHR = 5.1, 95% CI = 1.0-26.0) compared to those with SBP of 100-119 mm Hg, while higher SBP was associated with higher mortality. This J-curve association was generally maintained when analysis was restricted to those with fair or good self-rated health, or those with no known vascular diseases. In people below 65, increasing SBP nearly monotonically increased the mortality from all-cause and vascular diseases. Our results suggest that elderly persons with low SBP should be treated with caution, since low SBP may increase vascular mortality.
authors.affiliation: From the Department of Preventive Medicine and Public Health, Catholic Kwandong University, College of Medicine, Gangneung, Gangwon-do (S-WY); Department of Preventive Medicine (SH); and Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea (HO); Department of Preventive Medicine, Yonsei University College of Medicine (HO).
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Yi
authors.forename: Seri
authors.initials: S
authors.lastname: Hong
authors.forename: Heechoul
authors.initials: H
authors.lastname: Ohrr
mesh_terms: D000367:Age Factors; D000368:Aged; D001795:Blood Pressure Determination; D002423:Cause of Death; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D014652:Vascular Diseases / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology