title: Relationship of Blood Pressure With Mortality and Cardiovascular Events Among Hypertensive Patients aged ≥ 60 years in Rural Areas of China: A Strobe-Compliant Study.
abstract: The Eighth Joint National Committee (JNC-8) panel recently recommended a systolic blood pressure (BP) threshold of ≥ 150 mmHg for the initiation of drug therapy and a therapeutic target of <150/90 mmHg in patients ≥ 60 years of age. However, results from some post-hoc analysis of randomized controlled trials and observational studies did not support these recommendations. In the prospective cohort study, 5006 eligible hypertensive patients aged ≥ 60 years from rural areas of China were enrolled for the present analysis. The association between the average follow-up BP and outcomes (all-cause and cardiovascular death, incident coronary heart disease [CHD], and stroke), followed by a median of 4.8 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. The relationship between BP (systolic or diastolic) showed an increased or J-shaped curve association with adverse outcomes. Compared with the reference group of BP <140/90 mmHg, the risk of all-cause death (hazard ratio [HR]: 2.698; 95% confidence interval [CI]: 1.989-3.659), cardiovascular death (HR: 2.702; 95% CI: 1.855-3.935), incident CHD (HR: 3.263; 95% CI: 2.063-5.161), and stroke (HR: 2.334; 95% CI: 1.559-3.945) was still significantly increased in the group with BP of 140-149/<90 mmHg. Older hypertensive patients with BP of 140-149/<90 mmHg were at higher risk of developing adverse outcomes, implying that lenient BP control of 140-149/<90 mmHg, based on the JNC-8 guidelines, may not be appropriate for hypertensive patients aged ≥ 60 years in rural areas of China.
authors.affiliation: From the Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang (LZ); Department of Epidemiology, Tongji University Medical School, Shanghai (JL, DH); Department of Cardiology, Shengjing Hospital of China Medical University (ZS, YS); and Department of Cardiology, the First Affiliated Hospital of China Medical University, Shenyang, P.R. China (XZ).
authors.forename: Liqiang
authors.initials: L
authors.lastname: Zheng
authors.forename: Jue
authors.initials: J
authors.lastname: Li
authors.forename: Zhaoqing
authors.initials: Z
authors.lastname: Sun
authors.forename: Xingang
authors.initials: X
authors.lastname: Zhang
authors.forename: Dayi
authors.initials: D
authors.lastname: Hu
authors.forename: Yingxian
authors.initials: Y
authors.lastname: Sun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data