title: Treatment With Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents: The PARTAGE Study.
abstract: OBJECTIVE
  Clinical evidence supports the beneficial effects of lowering blood pressure (BP) levels in community-living, robust, hypertensive individuals older than 80 years. However, observational studies in frail elderly patients have shown no or even an inverse relationship between BP and morbidity and mortality.
  
  
  OBJECTIVE
  To assess all-cause mortality in institutionalized individuals older than 80 years according to systolic BP (SBP) levels and number of antihypertensive drugs.
  
  
  METHODS
  This longitudinal study included elderly residents of nursing homes. The interaction between low (<130 mm Hg) SBP and the presence of combination antihypertensive treatment on 2-year all-cause mortality was analyzed. A total of 1127 women and men older than 80 years (mean, 87.6 years; 78.1% women) living in nursing homes in France and Italy were recruited, examined, and monitored for 2 years. Blood pressure was measured with assisted self-measurements in the nursing home during 3 consecutive days (mean, 18 measurements). Patients with an SBP less than 130 mm Hg who were receiving combination antihypertensive treatment were compared with all other participants.
  
  
  METHODS
  All-cause mortality over a 2-year follow-up period.
  
  
  RESULTS
  A significant interaction was found between low SBP and treatment with 2 or more BP-lowering agents, resulting in a higher risk of mortality (unadjusted hazard ratio [HR], 1.81; 95% CI, 1.36-2.41); adjusted HR, 1.78; 95% CI, 1.34-2.37; both P < .001) in patients with low SBP who were receiving multiple BP medicines compared with the other participants. Three sensitivity analyses confirmed the significant excess of risk: propensity score-matched subsets (unadjusted HR, 1.97; 95% CI, 1.32-2.93; P < .001; adjusted HR, 2.05; 95% CI, 1.37-3.06; P < .001), adjustment for cardiovascular comorbidities (HR, 1.73; 95% CI, 1.29-2.32; P < .001), and exclusion of patients without a history of hypertension who were receiving BP-lowering agents (unadjusted HR, 1.82; 95% CI, 1.33-2.48; P < .001; adjusted HR, 1.76; 95% CI, 1.28-2.41; P < .001).
  
  
  CONCLUSIONS
  The findings of this study raise a cautionary note regarding the safety of using combination antihypertensive therapy in frail elderly patients with low SBP (<130 mm Hg). Dedicated, controlled interventional studies are warranted to assess the corresponding benefit to risk ratio in this growing population.
authors: Department of Geriatrics, University Hospital of Nancy, Nancy, France2Inserm, U1116, Université de Lorraine, Nancy, France3Inserm Clinical Investigation Centre, Université de Lorraine, CHU de Nancy, Nancy, France.
authors: Athanase
authors: A
authors: Benetos
authors: Inserm, U1116, Université de Lorraine, Nancy, France.
authors: Carlos
authors: C
authors: Labat
authors: Inserm, U1116, Université de Lorraine, Nancy, France3Inserm Clinical Investigation Centre, Université de Lorraine, CHU de Nancy, Nancy, France.
authors: Patrick
authors: P
authors: Rossignol
authors: Inserm Clinical Investigation Centre, Université de Lorraine, CHU de Nancy, Nancy, France.
authors: Renaud
authors: R
authors: Fay
authors: Department of Geriatrics, Toulouse University Hospital, Toulouse, France.
authors: Yves
authors: Y
authors: Rolland
authors: Division of Internal Medicine, Sacro Cuore Hospital, Negrar, Verona, Italy.
authors: Filippo
authors: F
authors: Valbusa
authors: Department of Cardiology, Istituto Auxologico Italiano, Milan, Italy.
authors: Paolo
authors: P
authors: Salvi
authors: Department of Geriatrics, University Hospital of Verona, Verona, Italy.
authors: Mauro
authors: M
authors: Zamboni
authors: Department of Geriatrics, University Hospital of Dijon, Dijon, France.
authors: Patrick
authors: P
authors: Manckoundia
authors: Department of Geriatrics, Broca Hospital, University Paris Descartes, Paris, France.
authors: Olivier
authors: O
authors: Hanon
authors: Department of Geriatrics, University Hospital of Nancy, Nancy, France.
authors: Sylvie
authors: S
authors: Gautier
mesh_terms: D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001794:Blood Pressure; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D005602:France; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007297:Inpatients / Q000706:statistics & numerical data; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality
chemical_list: D000959:Antihypertensive Agents