Blood pressure and 10-year mortality risk in the Milan Geriatrics 75+ Cohort Study: role of functional and cognitive status.
BACKGROUND
Optimal blood pressure targets in older adults are controversial.


OBJECTIVE
to investigate whether the relation of blood pressure with mortality in older adults varies by age, functional and cognitive status.


METHODS
longitudinal geriatric outpatient cohort.


METHODS
Milan Geriatrics 75+ Cohort Study.


METHODS
One thousand five hundred and eighty-seven outpatients aged 75 years and over.


METHODS
The relations of systolic (SBP) and diastolic blood pressure (DBP) with mortality risk were analysed using Cox proportional hazards models. Blood pressure, Mini-Mental State Examination (MMSE) and Basic Activities of Daily Living (ADL) were assessed at baseline. All analyses were adjusted for socio-demographic factors, co-morbidities and medications.


RESULTS
One thousand and forty-six patients died during 10-year follow-up. The relationships of SBP and DBP with mortality risk were U-shaped; SBP of 165 mmHg and DBP of 85 mmHg were associated with the lowest mortality. Patients with SBP < 120 mmHg and patients with SBP 120-139 mmHg had 1.64-fold (95% confidence intervals, CI 1.21-2.23) and 1.32-fold (95% CI 1.10-1.60) higher mortality risk than patients with SBP 160-179 mmHg (P values 0.001 and 0.004, respectively). In patients with SBP below 180 mmHg, higher SBP was associated with lower mortality in patients with impaired ADL and MMSE but not in those with preserved ADL and/or MMSE (P for interaction 0.033). Age did not modify the correlation of SBP with mortality.


CONCLUSIONS
The correlations of SBP and DBP with mortality were U-shaped. Higher SBP is related to lower mortality in subjects with impaired ADL and MMSE. ADL and MMSE may identify older subjects who benefit from higher blood pressure.
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Giulia
G
Ogliari
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands Public Health, University of Copenhagen, Copenhagen, Denmark.
Rudi G J
RG
Westendorp
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
Majon
M
Muller
Clinical Sciences and Community Health, University of Milan, Milan, Italy Geriatric Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Daniela
D
Mari
Clinical Chemistry and Microbiology Laboratory, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Erminio
E
Torresani
Clinical Chemistry and Microbiology Laboratory, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Irene
I
Felicetta
Geriatric Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Tiziano
T
Lucchi
Geriatric Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Paolo D
PD
Rossi
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Behnam
B
Sabayan
Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
Anton J M
AJ
de Craen
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D003072:Cognition Disorders / Q000401:mortality*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality; D009483:Neuropsychological Tests; D016016:Proportional Hazards Models; D012307:Risk Factors
blood pressure; cognitive status; functional status; geriatric outpatient cohort; mortality